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: Leads day-to-day operations for a team of Sales Investigators and Senior Sales Investigators responsible for investigating allegations of sales agent, agency, broker, and related sales-practice misconduct. Serves as the first-line people leader accountable for risk-based case assignment, investigative quality, timeliness, and consistent application of established standards. Ensures investigative work is documented in a clear, complete, and defensible manner and that team outputs are aligned with internal policies, CMS requirements, and audit/regulatory expectations. Partners with Compliance leadership, Legal, Sales, HR, and other stakeholders to address case-specific issues, implement corrective actions, and escalate systemic or high-risk concerns.
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Directly manages, coaches, and develops investigators and senior investigators; supports hiring, onboarding, performance management, and skills development to build and sustain a high-performing investigative team.
- Assigns and rebalances caseloads based on risk, complexity, investigator capability, and regulatory time sensitivity; monitors workflow to ensure timely completion of investigations and appropriate prioritization of higher-risk matters.
- Oversees day-to-day investigative execution for the team, including intake-to-closure progress, adherence to investigative protocols, and consistent use of approved templates, procedures, and documentation standards.
- Conducts formal quality review of investigative plans, evidence documentation, interview records, analysis, findings, and written reports; identifies deficiencies, provides coaching, and ensures work product meets established defensibility, accuracy, and completeness standards.
- Serves as the primary management escalation point for complex, sensitive, novel, or gray-area matters; reviews case direction and conclusions to promote consistent, risk-based application of standards and appropriate escalation of matters requiring senior leadership review.
- Ensures team members correctly apply relevant Medicare Advantage, Marketplace, Medicaid, and related sales conduct requirements, including CMS-aligned guidance and internal policy expectations; identifies competency gaps and coordinates targeted training and reinforcement.
- Partners 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.
- Tracks and reports operational and quality metrics, including case volume, timeliness, aging, quality trends, outcomes, and remediation follow-through; identifies recurring issues, emerging patterns, or control weaknesses and escalates systemic risk concerns to senior leadership.
- Reinforces disciplined case documentation, evidence organization, and file maintenance practices to support audit readiness, regulatory response, and consistent retention of investigative records.
- Supports implementation and continuous improvement of job aids, workflows, templates, and team procedures that promote consistency, effectiveness, and defensibility in investigative operations.
- Prepares or supports materials needed for audits, regulatory inquiries, internal oversight reviews, and management reporting by ensuring case records are complete, accessible, and supportable.
- Promotes a culture of sound investigative judgment, accountability, consistency, and continuous improvement within the team.
Candidate Education:
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A Bachelor's Degree in Criminal Justice, Law, Compliance, Healthcare Administration, or related field required or Associates with 6 years of applicable experience, or a High School/GED with 7 years of applicable experience may substitute for the Bachelors Degree
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5+ years of progressive experience in compliance, investigations, SIU, FWA, audit, or related functions in managed care, healthcare, or another similarly regulated environment required.
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1+ year of experience in leading or managing others required.
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Demonstrated experience reviewing investigative work product for quality, evidentiary sufficiency, and defensibility required.
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Demonstrated experience coordinating cross-functional case activity and remediation with business stakeholders required.
Preferred Qualifications
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2+ years of direct people leadership.
- Managed care or health plan experience.
- Experience 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.
Pay Range: $87,700.00 - $157,800.00 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
