Manager, Sales Investigations

🕒 il y a 1 mois

🐊 Florida, New York, +2 états de plus – Distant

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

💵 $87 700 - $157 800 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🤑 Commercial

Postuler Maintenant

Trouver des Emplois à Distance Similaires

Configurer une alerte email pour les nouveaux emplois

📊 Vérifiez votre score de CV pour ce poste

Améliorez vos chances d'obtenir un entretien en vérifiant votre score de CV avant de postuler.

Télécharger le CV

Centene Corporation

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1984

🛡️ Assurance

💼 Conseil

🏥 Santé

Insurance • Consulting • Healthcare

La société Centene Corporation est un leader dans la fourniture de services de santé subventionnés par le gouvernement, spécialisée dans la délivrance de solutions de santé abordables et de haute qualité. Depuis plus de 40 ans, Centene s’est concentrée sur la transformation de la santé des communautés en élargissant l'accès aux services de Medicaid, Medicare, et au marché de l'assurance santé, tout en servant les communautés militaires à travers le programme TRICARE. En tant que plus grande organisation de gestion des soins Medicaid et un acteur clé du marché, Centene met l'accent sur une prestation de soins de santé localisée combinée à des partenariats solides avec des organisations à but non lucratif pour répondre aux besoins uniques de ses membres. Centene s’engage également pour le développement durable et la responsabilité sociale des entreprises, en privilégiant la gestion environnementale et la gouvernance éthique afin d'améliorer le bien-être des communautés qu’elle dessert.

Description

• 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.

🎯 Exigences

• 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

🏖️ Avantages

• 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