Manager, Sales Investigations

Position Purpose

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.

Directing Day-to-Day Operations

• Directs the day-to-day operations of a team of Sales Investigators and Senior Sales Investigators.
• Maintains and develops a high-performing investigative team through coaching, performance management, and skills development.
• Assigns and rebalances caseloads based on risk, complexity, investigator capability, and regulatory time sensitivity.
• Maintains 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.

Quality Review and Escalation

• 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.

Compliance and Training

• 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.

Collaboration and Support

• Promotes coordination 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.

Documentation and Reporting

• 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.

Candidate Education

• 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.
• 5+ years of progressive experience in compliance, investigations, SIU, FWA, audit, or related functions in managed care, healthcare, or another similarly regulated environment required.
• 1+ year of experience in leading or managing others required.
• Demonstrated experience reviewing investigative work product for quality, evidentiary sufficiency, and defensibility required.
• Demonstrated experience coordinating cross-functional case activity and remediation with business stakeholders required.

Preferred Qualifications

• 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.

Benefits

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.