Manager, Sales Investigations

🕒 Junho 18

🐊 Florida, New York, +2 estados a mais – Remoto

🐊 Florida – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏰 Missouri – Remote

💵 $87.700 - $157.800 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🤑 Vendas

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Centene Corporation

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1984

🛡️ Seguros

💼 Consultoria

🏥 Saúde

Insurance • Consulting • Healthcare

Centene Corporation é uma provedora líder de serviços de saúde patrocinados pelo governo, especializada em oferecer soluções de saúde acessíveis e de alta qualidade. Há mais de 40 anos, a Centene tem se dedicado a transformar a saúde das comunidades, ampliando o acesso a Medicaid, Medicare e ao Health Insurance Marketplace, além de atender comunidades militares por meio do programa TRICARE. Como a maior organização de managed care do Medicaid e participante-chave no Marketplace, a Centene enfatiza a entrega de cuidados de saúde com foco local, combinada a parcerias sólidas com organizações sem fins lucrativos para atender às necessidades únicas de seus membros. A Centene também é comprometida com sustentabilidade corporativa e responsabilidade social, priorizando a gestão ambiental e a governança ética para promover o bem-estar das comunidades que atende.

Descrição

• 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. • Directly manages, coaches, and develops investigators and senior investigators; supports hiring, onboarding, performance management, and skills development to build and sustain a high-performing investigative team. • Assigns and rebalances caseloads based on risk, complexity, investigator capability, and regulatory time sensitivity; monitors workflow to ensure timely completion of investigations and appropriate prioritization of higher-risk matters. • Oversees day-to-day investigative execution for the team, including intake-to-closure progress, adherence to investigative protocols, and consistent use of approved templates, procedures, and documentation standards. • Conducts formal quality review of investigative plans, evidence documentation, interview records, analysis, findings, and written reports; identifies deficiencies, provides coaching, and ensures work product meets established defensibility, accuracy, and completeness standards. • Serves as the primary management escalation point for complex, sensitive, novel, or gray-area matters; reviews case direction and conclusions to promote consistent, risk-based application of standards and appropriate escalation of matters requiring senior leadership review. • Ensures team members correctly apply relevant Medicare Advantage, Marketplace, Medicaid, and related sales conduct requirements, including CMS-aligned guidance and internal policy expectations; identifies competency gaps and coordinates targeted training and reinforcement. • Partners with Legal, Compliance, HR, Sales Operations, and business leaders to coordinate interviews, obtain records, validate facts, align on remediation, and support appropriate corrective and disciplinary actions. • Tracks and reports operational and quality metrics, including case volume, timeliness, aging, quality trends, outcomes, and remediation follow-through; identifies recurring issues, emerging patterns, or control weaknesses and escalates systemic risk concerns to senior leadership. • Reinforces disciplined case documentation, evidence organization, and file maintenance practices to support audit readiness, regulatory response, and consistent retention of investigative records. • Supports implementation and continuous improvement of job aids, workflows, templates, and team procedures that promote consistency, effectiveness, and defensibility in investigative operations. • Prepares or supports materials needed for audits, regulatory inquiries, internal oversight reviews, and management reporting by ensuring case records are complete, accessible, and supportable. • Promotes a culture of sound investigative judgment, accountability, consistency, and continuous improvement within the team.

🎯 Requisitos

• 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 • 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 • Preferred Qualifications: 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

🏖️ Benefícios

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules