Senior Compliance Investigator | Remote

Centene Corporation; Colorado; Hybrid; USD 70,000 - 126,000; Full time

Job summary

Centene Corporation is seeking a seasoned Compliance Investigations leader for the Medical Management/Health Services team in the United States. You will help develop, implement, and continuously monitor an enterprise-wide Compliance Investigations Program and oversee investigations across Business Units, Health Plans, and Corporate functions.

You will lead ethics and compliance investigations, interview witnesses, review documents, prepare reports with remedial actions, and present findings to

Qualifications

• Bachelor's Degree in Related Field required or 5 years equivalent experience substituting degree.
• 4+ years of experience in investigations, auditing and risk analysis.
• 1+ year of experience reading, analyzing and interpreting State and Federal laws, rules and regulations.

Responsibilities

• Lead compliance and ethics investigations across all business units and health plans with thorough assessment of allegations.
• Evaluate applicable criteria including federal/state regulations and Code of Conduct.
• Adhere to investigation workplans and timelines and provide weekly case summaries.
• Document case files in Archer or other case management systems.
• Collaborate with Legal, People Relations, SIU, Privacy, Finance and Operations on investigations.
• Prepare and present findings to management and stakeholders; identify remedial actions.
• Track metrics (KPIs, aging, trends) and communicate insights to leadership.

Skills

Investigations

Auditing

Risk analysis

Regulatory knowledge

Education

Bachelor's degree in related field

Tools

Archer

Navex

Job description

Centene Corporation is seeking a seasoned Compliance Investigations leader for the Medical Management/Health Services team in the United States. You will help develop, implement, and continuously monitor an enterprise-wide Compliance Investigations Program and oversee investigations across Business Units, Health Plans, and Corporate functions.

You will lead ethics and compliance investigations, interview witnesses, review documents, prepare reports with remedial actions, and present findings to