Senior Director, Sales Investigations

Job not on LinkedIn

October 17

🐊 Florida – Remote

Although this job is listed in Florida, this company may be open to hiring remote in other states.

🌽 Illinois – Remote

Although this job is listed in Illinois, this company may be open to hiring remote in other states.

+2 more states

🐊 Florida – Remote 🌽 Illinois – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $145.1k - $268.8k / year

⏰ Full Time

🟠 Senior

🤑 Sales

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Centene Corporation

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 Description

• Serves as a strategic leader overseeing all enterprise-wide sales investigations, with a primary focus on Medicare sales • Leads a high-performing investigation team responsible for examining allegations of non-compliant or fraudulent sales practices involving agents and agencies • Ensures all investigative activities align with federal and state regulations, internal policies, and ethical standards, safeguarding the integrity of the organization's sales operations • Develop and execute the enterprise-wide strategy for sales investigations, ensuring timely, accurate, and consistent resolution of cases • Lead, mentor, and develop a team of investigators, ensuring alignment with company values, business priorities, and compliance expectations • Direct investigations into potential sales misconduct, fraud, misrepresentation, or non-compliant practices; oversee root cause analyses and corrective action planning • Ensure investigative practices comply with CMS, state insurance departments, and other regulatory bodies • Partner and build strong relationships with Compliance, Legal, HR, and Medicare plan and Sales leadership to mitigate risk and address systemic issues uncovered during investigations • Provide executive-level reporting on investigation outcomes, trends, and risks; advise senior leadership on proactive risk management strategies • Continuously evaluate and enhance investigative methodologies, tools, and training to ensure best-in-class processes • Manage vendor and contractor relationships to ensure compliance with contracts and effective delivery of services supporting the Sales Investigations team • Develop preventative strategies, including controls, monitoring, and training, to reduce recurrence of sales-related issues • Serve as a trusted advisor to senior leadership on ethical sales practices and reputational risk • Performs other duties as assigned

🎯 Requirements

• Bachelor’s degree compliance, legal studies, related field or equivalent experience required; master’s degree or Juris Doctor (JD) preferred • 7+ years progressive experience in investigations, compliance, sales oversight, or regulatory affairs within healthcare, insurance, or managed care required • 5+ years management experience managing investigative, sales operations or compliance team required • Strong understanding of Medicare product sales practices, CMS regulations, and Medicare guidelines required • Proven ability to handle complex, sensitive investigations with discretion and integrity required • Exceptional analytical, communication, and problem-solving skills required • Demonstrated ability to influence senior executives and collaborate across functions required.

🏖️ Benefits

• 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