Principal Compliance Investigator

Centene Corporation

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for leading and managing the most complex, sensitive, and high-impact internal investigations across the organization. Serves as a strategic advisor and subject matter expert on investigative best practices, regulatory compliance, and risk mitigation. Requires exceptional judgment, discretion, and the ability to influence senior leadership decisions while ensuring adherence to federal and state regulations, internal policies, and ethical standards. Consults with management, in-house counsel, and/or the Director of Corporate Compliance as needed to resolve difficult, highly sensitive or complex compliance issues. Independently evaluates and assesses allegations to determine whether domestic laws, regulatory policies, or internal policies, procedures, and standards have been violated. Plans, scopes, and conducts complex, confidential internal investigations from inception to conclusion. This includes defining investigation strategy, preserving evidence, conducting interviews, analyzing records, conducting root cause analysis, and recommended corrective and disciplinary actions. Conducts, manages, and documents interviews with witnesses, as required for investigatory purposes. Reviews investigation reports prepared by junior investigators. Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks. Performs follow up to ensure remedial / disciplinary measures are implemented appropriately and timely. Plans, develops, leads, and manages multiple projects, including prioritizing and managing through execution. Maintains meticulous case files and chronologies in accordance with best practices. Thoroughly documents, organizes, and reviews case files, electronic and hardcopy, relative to each investigation in accordance with Company policy and ensures remediation activities are tracked and implemented. Prepares clear and concise draft investigation plans and reports. Provides support and guidance to junior investigation staff as applicable. Attends, actively participates in, and/or leads meetings with various business area managers. Communicates directly with Federal or State regulators. Supports the development and maintenance of Corporate Compliance policies and procedures and workflows. Participates in and leads special projects (e.g., auditing, training, and HIPAA compliance). Provides support of and guidance to other associates. Performs other duties as assigned. Complies with all policies and standards.

Requirements

Bachelor's Degree Criminal Justice/Criminology, Law, Healthcare Administration/Health Policy, or related field, equivalent experience required.
7+ years progressive experience in conducting and managing complex investigations or auditing and risk analysis required.
7+ years experience reading, analyzing and interpreting State and Federal laws, rules and regulations required.

Nice To Haves

Juris Doctorate highly preferred.
Prosecutorial experience preferred.
Previous experience as an investigator within a large corporation or Federal Agency preferred.
Certified Fraud Investigator preferred

Responsibilities

Responsible for leading and managing the most complex, sensitive, and high-impact internal investigations across the organization.
Serves as a strategic advisor and subject matter expert on investigative best practices, regulatory compliance, and risk mitigation.
Consults with management, in-house counsel, and/or the Director of Corporate Compliance as needed to resolve difficult, highly sensitive or complex compliance issues.
Independently evaluates and assesses allegations to determine whether domestic laws, regulatory policies, or internal policies, procedures, and standards have been violated.
Plans, scopes, and conducts complex, confidential internal investigations from inception to conclusion.
Conducts, manages, and documents interviews with witnesses, as required for investigatory purposes.
Reviews investigation reports prepared by junior investigators.
Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks.
Performs follow up to ensure remedial / disciplinary measures are implemented appropriately and timely.
Plans, develops, leads, and manages multiple projects, including prioritizing and managing through execution.
Maintains meticulous case files and chronologies in accordance with best practices.
Thoroughly documents, organizes, and reviews case files, electronic and hardcopy, relative to each investigation in accordance with Company policy and ensures remediation activities are tracked and implemented.
Prepares clear and concise draft investigation plans and reports.
Provides support and guidance to junior investigation staff as applicable.
Attends, actively participates in, and/or leads meetings with various business area managers.
Communicates directly with Federal or State regulators.
Supports the development and maintenance of Corporate Compliance policies and procedures and workflows.
Participates in and leads special projects (e.g., auditing, training, and HIPAA compliance).
Provides support of and guidance to other associates.
Performs other duties as assigned.
Complies with all policies and standards.