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.

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.