Compliance Investigator

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: Position investigates and remediates compliance and sales & marketing related matters deemed to be of moderate to high complexity. Supports and leads complex investigations and prepares and reviews internal and external reporting. Supports the Senior Manager, Compliance Investigations in the day-to-day Corporate Compliance functions under WellCare's Corporate Compliance Program.

• Independently evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare & Medicaid Services (“CMS”) guidelines, and internal policies, procedures, and standards that are alleged to have been violated.

• Prepares and analyzes Company and departmental metrics including, but not limited to, Sales & Marketing activities, internal investigations and makes recommendations accordingly.

• Prepares presentations for departmental and business management and other stakeholders.

• Conducts and documents interviews with beneficiaries, sales agents, providers, associates, and/or downstream entities as required for investigatory purposes.

• Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks.

• Plans, develops, and leads multiple projects, including prioritizing and managing through execution.

• Thoroughly documents, organizes, and reviews case files, electronic and hardcopy, relative to each investigation in accordance with Company policy and ensures remediation activities are tracked and implemented.

• Provides support and guidance to junior investigative staff as applicable.

• Prepares clear and concise draft investigative plans and reports.

• Attends business meetings with various business area managers.

• Supports the development and maintenance of Corporate Compliance policies and procedures and workflows.

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience:
Required: Bachelor's Degree in Related Field with 3+ years of experience in investigations, auditing and risk analysis
OR Associates Degree with 4 years of applicable experience,

OR High School/GED with 5 years of applicable experience may substitute for the Bachelors Degree

Candidate Experience: Required 3+ years of experience in investigations, auditing and risk analysis
Preferred Skills: Managed care or health insurance company, reading, analyzing and interpreting State and Federal laws, rules and regulations
 

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.  Total compensation may also include additional forms of incentives.

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