Centene

1 month ago

Manager, Sales Investigations

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 6 hours agoStatus: Live

Job Summary

Lead a team of Sales Investigators and Senior Sales Investigators to investigate sales misconduct, ensure timely, defensible case work, and align investigations with CMS requirements and internal policies. Manage risk-based caseloads, coach staff, review quality, escalate complex matters, and partner with Compliance, Legal, HR, and Sales to drive remediation and process improvements.

Location: Florida

Workplace: Remote

Employment Type: Full time

Job Function: Sales

Seniority: Manager level

Key Responsibilities

•Lead day-to-day operations for a team of Sales Investigators and Senior Sales Investigators, ensuring risk-based case assignment, investigative quality, timeliness, and adherence to standards.
•Assign and rebalance caseloads based on risk, complexity, and regulatory time sensitivity; monitor workflow for timely completion and prioritize high-risk matters.
•Oversee intake-to-closure progress and adherence to approved templates, procedures, and documentation standards.
•Conduct formal quality reviews of plans, evidence, interview records, findings, and reports; coach for defensibility and accuracy.
•Act as primary escalation point for complex matters and coordinate with Legal, Compliance, HR, and Sales Operations to remediate and escalate as needed.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually

Equity and Bonus:Equity

Perks:Health Insurance401kEquity

Key Requirements

•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

Experience:5+ yearsHealthcareManaged careRegulated environment

Education:Bachelor's

Skills:LeadershipCoachingQuality assuranceProcess improvementStakeholder management

Certifications:CFEAHFICIACHC/HCCACCP

Company Brief

Centene

Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn

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Centene

1 month ago

Manager, Sales Investigations

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 6 hours agoStatus: Live

Job Summary

Location: Florida

Workplace: Remote

Employment Type: Full time

Job Function: Sales

Seniority: Manager level

Key Responsibilities

•Lead day-to-day operations for a team of Sales Investigators and Senior Sales Investigators, ensuring risk-based case assignment, investigative quality, timeliness, and adherence to standards.
•Assign and rebalance caseloads based on risk, complexity, and regulatory time sensitivity; monitor workflow for timely completion and prioritize high-risk matters.
•Oversee intake-to-closure progress and adherence to approved templates, procedures, and documentation standards.
•Conduct formal quality reviews of plans, evidence, interview records, findings, and reports; coach for defensibility and accuracy.
•Act as primary escalation point for complex matters and coordinate with Legal, Compliance, HR, and Sales Operations to remediate and escalate as needed.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually

Equity and Bonus:Equity

Perks:Health Insurance401kEquity

Key Requirements

•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

Experience:5+ yearsHealthcareManaged careRegulated environment

Education:Bachelor's

Skills:LeadershipCoachingQuality assuranceProcess improvementStakeholder management

Certifications:CFEAHFICIACHC/HCCACCP

Company Brief

Centene

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn