[Remote] Senior Manager, Sales Investigations

Note: The job is a remote job and is open to candidates in USA. Centene Corporation is transforming the health of communities, serving 28 million members. The Senior Manager of Sales Investigations leads and develops a high-performing investigative team, overseeing operations related to Medicare Advantage agent misconduct and ensuring compliance with regulatory standards.ResponsibilitiesProvides 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 risksApplies 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 allegationsEstablishes, 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 scrutinySets 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 actionsLeverages 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 riskDirects 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 investigationsOversees and governs investigation-related policy and program frameworks, including sales investigations operating procedures, any program integration, and compliance training requirements and contentLeads, coaches, and develops multi-layer teams, including SIT managers and investigators; drive talent development, workload planning, and a culture of integrity, consistency, and continuous improvementEnsures consistent application of investigative outcomes, including recommendations for disciplinary actions, contract actions, agent/agency remediation, corrective action plans, and control enhancementsPerforms other duties as assignedComplies with all policies and standardsSkillsBachelor's Degree Compliance, Law, Criminal Justice or related field; or equivalent experience required6+ years Compliance, investigations, law enforcement leadership, SIU, FWA, audit, and/or regulatory functions within managed care, a healthcare payor, or a similarly regulated environment requiredExperience working with Medicare Advantage sales distribution structures, including the relationships and contractual obligations among first-tier, downstream, and related entities (FDRs) requiredExperience 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 requiredMaster's Degree preferredJuris Doctor (JD) preferred2+ years Leading people leaders and/or multi-layer teams preferredHCCA (CHC/CHPC), CFE, AHFI, CPCI, CPA, CIA, or other industry-related certification preferredBenefitsCompetitive payHealth insurance401K and stock purchase plansTuition reimbursementPaid time off plus holidaysA flexible approach to work with remote, hybrid, field or office work schedulesActual 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 statusTotal compensation may also include additional forms of incentivesBenefits may be subject to program eligibilityCompany OverviewCentene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. It was founded in 1984, and is headquartered in St Louis, Missouri, USA, with a workforce of 10001+ employees. Its website is http://centene.com.