Manager, Sales Investigations

Centene Corporation•Remote-FL, MO

3d•$87,700 - $157,800•Remote

About The Position

Leads day-to-day operations for a team of Sales Investigators and Senior Sales Investigators responsible for investigating allegations of sales agent, agency, broker, and related sales-practice misconduct. Serves as the first-line people leader accountable for risk-based case assignment, investigative quality, timeliness, and consistent application of established standards. Ensures investigative work is documented in a clear, complete, and defensible manner and that team outputs are aligned with internal policies, CMS requirements, and audit/regulatory expectations. Partners with Compliance leadership, Legal, Sales, HR, and other stakeholders to address case-specific issues, implement corrective actions, and escalate systemic or high-risk concerns. Manage Compliance Investigations Unit ("CIU") staff, ensuring timely, accurate, complete, professional, and ethical investigations, investigatory reports, and remediation. Manage investigations resulting from allegations of misconduct reported to Compliance department, consulting with the Director to determine the need for escalation for each such report and ensuring timely, appropriate resolution of matter. Ensures that reports are referred to other business areas, including Legal and HR, as appropriate for inquiry by such department. Prepare summary reports and analyze trends or patterns resulting from allegations of misconduct. Assist director in preparing reports regarding investigations for senior management and the board of directors. Collaborate with other corporate business owners and market staff in obtaining information necessary for investigations, and in remedying issues that may be causing compliance concerns. Develop various aspects of corporate compliance training materials. Create and maintain investigatory policies and procedures. Responsible for the CIU's meeting all response deadlines imposed by federal and state requirements. Supervise and develop investigatory staff. Performs special projects and other duties as assigned.

Requirements

A Bachelor's Degree in Criminal Justice, Law, Compliance, Healthcare Administration, or related field required or Associates with 6 years of applicable experience, or a High School/GED with 7 years of applicable experience may substitute for the Bachelors Degree
5+ years of progressive experience in compliance, investigations, SIU, FWA, audit, or related functions in managed care, healthcare, or another similarly regulated environment required.
1+ year of experience in leading or managing others required.
Demonstrated experience reviewing investigative work product for quality, evidentiary sufficiency, and defensibility required.
Demonstrated experience coordinating cross-functional case activity and remediation with business stakeholders required.

Nice To Haves

2+ years of direct people leadership.
Managed care or health plan experience.
Experience supporting audit responses, regulatory inquiries, or oversight reviews.
Working knowledge of Medicare sales and marketing compliance expectations, including CMS Chapter 42 and related CMS marketing guidance.
Professional certification such as CFE, AHFI, CIA, CHC/HCCA, CCP, or similar.

Responsibilities

Leads day-to-day operations for a team of Sales Investigators and Senior Sales Investigators responsible for investigating allegations of sales agent, agency, broker, and related sales-practice misconduct.
Serves as the first-line people leader accountable for risk-based case assignment, investigative quality, timeliness, and consistent application of established standards.
Ensures investigative work is documented in a clear, complete, and defensible manner and that team outputs are aligned with internal policies, CMS requirements, and audit/regulatory expectations.
Partners with Compliance leadership, Legal, Sales, HR, and other stakeholders to address case-specific issues, implement corrective actions, and escalate systemic or high-risk concerns.
Manage Compliance Investigations Unit ("CIU") staff, ensuring timely, accurate, complete, professional, and ethical investigations, investigatory reports, and remediation.
Manage investigations resulting from allegations of misconduct reported to Compliance department, consulting with the Director to determine the need for escalation for each such report and ensuring timely, appropriate resolution of matter.
Ensures that reports are referred to other business areas, including Legal and HR, as appropriate for inquiry by such department.
Prepare summary reports and analyze trends or patterns resulting from allegations of misconduct.
Assist director in preparing reports regarding investigations for senior management and the board of directors.
Collaborate with other corporate business owners and market staff in obtaining information necessary for investigations, and in remedying issues that may be causing compliance concerns.
Develop various aspects of corporate compliance training materials.
Create and maintain investigatory policies and procedures.
Responsible for the CIU's meeting all response deadlines imposed by federal and state requirements.
Supervise and develop investigatory staff.
Performs special projects and other duties as assigned.