Senior Compliance Investigator

🔥 0 minutes ago

🌵 Arizona, Kansas, +3 more states – Remote

🌵 Arizona – Remote 🌪️ Kansas – Remote 🌾 Nebraska – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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.

📋 Description

• Assist with development, implementation, and continuous monitoring of an enterprise-wide Compliance Investigations Program • Lead and oversee compliance and ethics investigations across all business units, health plans, and corporate functions • Facilitate and lead meetings with business management and cross-functional stakeholders • Assess allegations and review relevant documents • Conduct witness interviews, analyze facts, perform root cause analysis, and prepare investigation reports with recommended remedial or disciplinary actions • Evaluate allegations against federal and state regulations, the Centene Code of Conduct, and internal policies, procedures, and standards • Follow Compliance Investigation workplans, protocols, and timelines • Provide weekly case summaries and meet minimum case review quotas • Tie investigative findings to company policies and regulations to support regulatory defensibility and remediation • Report investigation status and outcomes orally and in writing to the Director of Ethics & Investigations and/or senior management • Document, organize, and review case files in centralized case management systems such as Archer • Collaborate with Legal, People Relations, SIU, Privacy, Finance, and Business Operations • Prepare and analyze investigation KPIs, case aging, and trending data • Prepare presentations and present findings to management, executive leadership, and stakeholders • Identify risks and recommend remedial actions to mitigate future risks • Track remediation and disciplinary measures through case management systems • Assist with projects assigned by the Director of Ethics & Investigations or VP of Compliance Investigations • Perform other assigned duties and comply with company policies and standards

🎯 Requirements

• Bachelor's Degree in a related field, or Associate's degree with 5 years of applicable experience, or High School/GED with 6 years of applicable experience may substitute for the Bachelor's Degree • 4+ years of experience in investigations, auditing, and risk analysis • 1+ year of experience reading, analyzing, and interpreting state and federal laws, rules, and regulations • Managed care or health insurance company experience preferred • Experience with compliance case management systems such as Archer or Navex preferred • Experience conducting ethics and compliance investigations in a regulated healthcare environment preferred • Experience collaborating with cross-functional teams including Legal, People Relations, SIU, and Privacy preferred • Certified Fraud Examiner (CFE) preferred • Certified Compliance & Ethics Professional (CCEP) or Certified Healthcare Compliance (CHC) preferred • Must comply with all company policies and standards

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation