Senior Compliance Investigator

This is a fully remote position, open to applicants in Arizona, +4 more states.

📋 Description

• Support the development, execution, and ongoing monitoring of a comprehensive Compliance Investigations Program across the enterprise.

• Direct and manage compliance and ethics investigations across all business divisions, health plans, and corporate departments.

• Organize and lead discussions with business management and cross-functional stakeholders.

• Evaluate allegations and assess pertinent documentation.

• Conduct interviews with witnesses, analyze information, execute root cause analysis, and compile investigation reports with suggested remedial or disciplinary actions.

• Examine allegations against federal and state regulations, the Centene Code of Conduct, as well as internal policies, procedures, and standards.

• Adhere to Compliance Investigation workplans, protocols, and deadlines.

• Provide weekly summaries of cases and meet established case review quotas.

• Link investigative outcomes to company policies and regulations to ensure regulatory defensibility and remediation.

• Communicate the status and results of investigations both verbally and in writing to the Director of Ethics & Investigations and/or senior management.

• Document, organize, and assess case files within centralized case management systems like Archer.

• Collaborate with Legal, People Relations, SIU, Privacy, Finance, and Business Operations.

• Prepare and evaluate investigation KPIs, case aging, and trend data.

• Develop presentations and present findings to management, executive leadership, and stakeholders.

• Identify potential risks and propose remedial actions to reduce future risks.

• Monitor remediation and disciplinary actions through case management systems.

• Assist with projects assigned by the Director of Ethics & Investigations or the VP of Compliance Investigations.

• Carry out other assigned duties and adhere to company policies and standards.

⛳️ Requirements

• Bachelor's Degree in a related field; alternatively, an Associate's degree with 5 years of relevant experience, or a High School/GED with 6 years of relevant experience may substitute for the Bachelor's Degree.

• A minimum of 4 years of experience in investigations, auditing, and risk analysis.

• At least 1 year of experience in reading, analyzing, and interpreting state and federal laws, rules, and regulations.

• Experience in managed care or health insurance companies is preferred.

• Familiarity with compliance case management systems such as Archer or Navex is preferred.

• Background in conducting ethics and compliance investigations within a regulated healthcare environment is preferred.

• Experience working with cross-functional teams including Legal, People Relations, SIU, and Privacy is preferred.

• Certified Fraud Examiner (CFE) designation is preferred.

• Certification as a Compliance & Ethics Professional (CCEP) or Certified Healthcare Compliance (CHC) is preferred.

• Must adhere to all company policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

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

• Additional forms of incentives may be included in total compensation.