Senior Manager, Sales Investigations at Centene

You're a seasoned leader with at least six years of experience in compliance, investigations, or law enforcement within managed care or a similarly regulated he

Work type: remote

Location: Remote-MO | Remote-FL | Remote-IN | Remote-NC | Remote-TX | Remote-IL | Remote-KY

Salary: $107,700 – $199,300/yr

Type: Full-time

Summary

You're a seasoned leader with at least six years of experience in compliance, investigations, or law enforcement within managed care or a similarly regulated healthcare environment, holding a Bachelor's degree or equivalent experience. **What makes it worth a look...** This full-time, fully remote role at Centene offers a substantial salary range of $107,700 - $199,300 per year. **You might be a good fit if you...** * Have experience with Medicare Advantage sales distribution structures (FDRs, captive agents, independent brokers). * Understand and can apply investigative standards and protocols for misconduct allegations. * Can leverage data analysis to identify systemic issues and drive corrective actions. * Have led people leaders and multi-layer teams.

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose:Serves as a senior leader and subject matter expert, guiding and developing managers to build a high-performing, compliance-focused investigative team. Provides enterprise-wide leadership for the Sales Investigations Team (SIT), with direct oversight of day-to-day investigative operations. Directs the investigation of Medicare Advantage agent and agency misconduct allegations, including sales-related violations, fraud, waste, and abuse (FWA) concerns referred through hotline, regulatory, and special investigation channels.

• 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.

• Bachelor's Degree Compliance, Law, Criminal Justice or related field; or equivalent experience required


• Master's Degree preferred


• Juris Doctor (JD) preferred


• 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


• 2+ years Leading people leaders and/or multi-layer teams. preferred


• 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

Pay Range: $107,700.00 - $199,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and 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.

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