Manager, Sales Investigations

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Oversees the daily operations of a team consisting of Sales Investigators and Senior Sales Investigators tasked with probing allegations of misconduct regarding sales agents, agencies, brokers, and related sales practices.

• Acts as the primary people leader responsible for risk-based case assignments, ensuring investigative quality, promptness, and the consistent application of established standards.

• Guarantees that investigative work is documented in a clear, thorough, and defensible manner, aligning team outputs with internal policies, CMS requirements, and audit/regulatory expectations.

• Collaborates with Compliance leadership, Legal, Sales, HR, and other stakeholders to address specific case issues, implement corrective measures, and escalate systemic or high-risk concerns.

• Directly supervises, coaches, and develops investigators and senior investigators; assists in hiring, onboarding, performance management, and skills development to cultivate a high-performing investigative team.

• Assigns and adjusts caseloads based on risk, complexity, investigator capabilities, and regulatory urgency; monitors workflow to ensure timely investigation completion and appropriate prioritization of higher-risk cases.

• Manages the daily investigative execution for the team, including tracking progress from intake to closure, adhering to investigative protocols, and consistently utilizing approved templates, procedures, and documentation standards.

• Conducts formal quality assessments of investigative plans, evidence documentation, interview records, analysis, findings, and written reports; identifies deficiencies, offers coaching, and ensures the work product meets established defensibility, accuracy, and completeness standards.

• Serves as the main management escalation point for complex, sensitive, novel, or ambiguous matters; reviews case direction and conclusions to ensure consistent, risk-based application of standards and appropriate escalation of issues requiring senior leadership review.

• Ensures that team members accurately apply relevant Medicare Advantage, Marketplace, Medicaid, and related sales conduct requirements, including CMS-aligned guidance and internal policy expectations; identifies competency gaps and organizes targeted training and reinforcement.

• Collaborates 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.

• Monitors and reports on operational and quality metrics, including case volume, timeliness, aging, quality trends, outcomes, and remediation follow-up; identifies recurring issues, emerging patterns, or control weaknesses and escalates systemic risk concerns to senior leadership.

• Reinforces disciplined practices in case documentation, evidence organization, and file maintenance to support audit readiness, regulatory responses, and consistent retention of investigative records.

• Aids in the implementation and continuous improvement of job aids, workflows, templates, and team procedures that enhance consistency, effectiveness, and defensibility in investigative operations.

• Prepares or assists in creating materials needed for audits, regulatory inquiries, internal oversight reviews, and management reporting by ensuring case records are complete, accessible, and supportable.

• Fosters a culture of sound investigative judgment, accountability, consistency, and continuous improvement within the team.

⛳️ Requirements

• A Bachelor's Degree in Criminal Justice, Law, Compliance, Healthcare Administration, or a related field is required OR an Associate's Degree with 6 years of applicable experience, OR a High School/GED with 7 years of applicable experience.

• A minimum of 5 years of progressive experience in compliance, investigations, SIU, FWA, audit, or related functions within managed care, healthcare, or another similarly regulated environment is required.

• At least 1 year of experience in leading or managing others is required.

• Proven experience in reviewing investigative work products for quality, evidentiary sufficiency, and defensibility is required.

• Demonstrated experience in coordinating cross-functional case activities and remediation with business stakeholders is required.

• Preferred Qualifications: 2+ years of direct people leadership experience.

• Experience in managed care or health plan settings.

• Experience in 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 is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement options.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.