Ethics & Investigations Officer

Centene; United States; Remote; USD 250,000 - 625,000; Full time

Job summary

Centene is seeking an Executive to lead compliance and ethics functions, ensuring adherence to legal standards and promoting a culture of integrity. The role involves strategic oversight of compliance investigations related to fraud and necessitates significant experience in the healthcare sector, making it a pivotal position for their operations.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• 15+ years of progressive experience in compliance or related field.
• 7+ years of experience with compliance solutions like HIPAA.
• Experience in healthcare industry preferred.

Responsibilities

• Manage compliance, ethics, and investigations functions.
• Oversee internal investigations into fraud, waste, abuse.
• Partner with executive leadership to align ethics initiatives.

Skills

Compliance expertise

Ethics management

Risk analysis

Fraud detection

Leadership

Education

Bachelor’s degree in Law, Business Administration, or related field

Master's Degree (CPA, CISA, MHA, etc.)

Job description

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

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

Position Purpose:
Responsible for leading and managing the company's compliance, ethics, and investigative functions and the company's enterprise-wide ethics investigations strategy. Ensures the organization's adherence to legal, regulatory, and ethical standards while fostering a culture of integrity and accountability. Provide strategic oversight of ethics investigations related to fraud, waste, abuse, and conflicts of interest, ensuring prompt and effective resolution of compliance concerns. Drive a culture of integrity, transparency, and risk mitigation through a robust code of conduct.

• Leads the development and execution of enterprise-wide ethics investigation strategy, ensuring regulatory compliance across all business units and markets.
• Provide oversight of internal investigations into allegations of fraud, waste, abuse, and conflicts of interest. Establish and maintain investigative protocols, ensuring consistent and fair processes. Ensure proper documentation and reporting of investigations in accordance with legal and regulatory guidelines. Coordinate with external regulators, law enforcement, and other stakeholders when necessary.
• Partner with executive leadership to align ethics and investigation initiatives with corporate goals and strategy.
• Advise the Board of Directors and executive teams on ethics and Fraud, Waste and Abuse trends, risk exposure, and regulatory developments.
• Utilize data-driven insights and risk analytics to enhance ethics monitoring, investigative processes, and decision-making.
• Drive efficiency within compliance operations, with a focus on process optimization, risk mitigation, and internal controls.
• Lead a strategically focused team to support growth, efficiency, and positive outcomes in alignment with Centene’s core values.
• Integrate technology and automation strategies to enhance ethics and compliance effectiveness and streamline investigative processes.
• Champions a culture of ethics and compliance across all levels of the organization.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor’s degree in Law, Business Administration, Healthcare Administration or related field required; Master's Degree CPA, CISA, MHA, MBA, MIS, Juris Doctor (JD) or related field preferred

• 15+ years of progressive experience in compliance, ethics, investigations, or related field required

• 7+ years Implementing business initiatives in process, risk, and control measure required

• 7+ years Experience with compliance focused solutions (HIPAA, NAIC, CMS, SOX, etc.) required

• 7+ years Experience in fraud detection and prevention, regulatory compliance, and corporate ethics preferred
  Healthcare industry experience preferred

Licenses/Certifications:

• Certified Compliance & Ethics Professional (CCEP), Certified Fraud Examiner (CFE), or similar certification preferred

Pay range: $250,000 - $625,000 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