Note: The job is a remote job and is open to candidates in USA. Centene Corporation is transforming the health of communities, serving 28 million members. The Senior Manager of Sales Investigations leads and develops a high-performing investigative team, overseeing operations related to Medicare Advantage agent misconduct and ensuring compliance with regulatory standards.
Responsibilities
- Provides enterprise-wide strategic and operational leadership for the Sales Investigations Team (SIT), including oversight of allegation intakes, regulatory-driven matters, and investigations involving sales practices, agent/agency conduct, and related FWA risks
- Applies working knowledge of Medicare Advantage sales distribution structures, including FDR relationships, captive agent employment arrangements, and independent broker/agency contracts, to appropriately scope, contextualize, and adjudicate misconduct allegations
- Establishes, maintains, and governs investigation standards, protocols, and quality controls (case triage, scoping, investigative plans, interviews, documentation, evidence handling, chain-of-custody, and retention) to ensure cases withstand regulatory, audit, and legal scrutiny
- Sets interpretation standards for agent, agency, broker, and sales operations misconduct, including identification and assessment of novel or emerging schemes; recommend enterprise posture, mitigations, and corrective actions
- Leverages data analysis and trend interpretation to identify systemic issues, serve as evidence within investigations, and drive enterprise-level corrective action strategies that demonstrably reduce recurrence and mitigate compliance risk
- Directs coordination and communication with external stakeholders as appropriate, including CMS, state regulators, and law enforcement agencies; prepare and support responses to regulatory inquiries, audits, and investigations
- Oversees and governs investigation-related policy and program frameworks, including sales investigations operating procedures, any program integration, and compliance training requirements and content
- Leads, coaches, and develops multi-layer teams, including SIT managers and investigators; drive talent development, workload planning, and a culture of integrity, consistency, and continuous improvement
- Ensures consistent application of investigative outcomes, including recommendations for disciplinary actions, contract actions, agent/agency remediation, corrective action plans, and control enhancements
- Performs other duties as assigned
- Complies with all policies and standards
Skills
- Bachelor's Degree Compliance, Law, Criminal Justice or related field; or equivalent experience required
- 6+ years Compliance, investigations, law enforcement leadership, SIU, FWA, audit, and/or regulatory functions within managed care, a healthcare payor, or a similarly regulated environment required
- Experience working with Medicare Advantage sales distribution structures, including the relationships and contractual obligations among first-tier, downstream, and related entities (FDRs) required
- Experience working with Medicare Advantage sales distribution models, including first-tier, downstream, and related entity (FDR) structures, captive agent employment arrangements, and independent broker/agency contracting required
- Master's Degree preferred
- Juris Doctor (JD) preferred
- 2+ years Leading people leaders and/or multi-layer teams preferred
- HCCA (CHC/CHPC), CFE, AHFI, CPCI, CPA, CIA, or other industry-related certification preferred
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
- Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status
- Total compensation may also include additional forms of incentives
- Benefits may be subject to program eligibility
Company Overview
Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. It was founded in 1984, and is headquartered in St Louis, Missouri, USA, with a workforce of 10001+ employees. Its website is http://centene.com.