Job Description

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.

Applicants for this role have the flexibility to work remotely anywhere in the Continental United States.

Position Purpose: 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.
• Comply with all policies and standards.

Education/Experience:

• 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.

Pay Range: $145,100.00 - $268,800.00 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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Job Tags

Full time, Part time, For contractors, Work at office, Remote work, Flexible hours,

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