Centene Corp

Senior Compliance Investigator

Centene Corp • $70K — $126K *
US-Anywhere
+ 13 other locationsRemote
Legal & Accounting
Less than 5 years of experience
3 days ago
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in a related field or Associates with 5 years of experience, or High School/GED with 6 years of experience in lieu of a degree.
  • 4+ years in investigations, auditing, and risk analysis.
  • 1+ year in reading and analyzing State and Federal laws and regulations.
  • Preferred experience in managed care or health insurance environments.
  • Knowledge of compliance case management systems (e.g., Archer, Navex) is preferred.

Responsibilities

  • Lead compliance and ethics investigations across all business units and health plans.
  • Evaluate allegations to determine adherence to regulations and company policies.
  • Adhere to investigation protocols and conduct investigations within established timelines.
  • Provide weekly summaries and manage case review quotas for timely resolution.
  • Document and organize case files within case management systems.
  • Collaborate with cross-functional departments on investigative processes.
  • Prepare analysis of investigation metrics and make recommendations for improvements.

Benefits

  • Competitive pay and health insurance.
  • 401K and stock purchase plans.
  • Tuition reimbursement and paid time off plus holidays.
  • Flexible work options including remote, hybrid, field, or office schedules.
Full Job Description
Position Purpose: Under the general direction of the VP of Compliance Investigations this position assists with the development, implementation, and continuous monitoring of an enterprise-wide Compliance Investigations Program and leads the Company's Compliance Investigations for all Business Units, Health Plans, and Corporate functions. Leads and oversees compliance and ethics investigations, facilitates and leads meetings with business management and cross-functional stakeholders, and prepares, reviews, and analyzes internal and external reporting. Supports the Director, Ethics & Investigations in the day-to-day operations of the Compliance Investigations Unit (CIU).

  • Leads and conducts compliance and ethics investigations across all business units and health plans, including but not limited to assessment of allegations, review of relevant documents, witness interviews, analysis of facts, root cause analysis, and preparation of investigation reports with recommended remedial or disciplinary actions.
  • Independently evaluates and assesses allegations to determine applicable criteria, including federal and state regulations, the Centene Code of Conduct, and internal policies, procedures, and standards that are alleged to have been violated.
  • Adheres to Compliance Investigation workplans and protocols and conducts investigations in compliance with established protocols and timelines.
  • Provides weekly case summaries and adheres to established minimum case review quotas to ensure timely progression and resolution of the investigative caseload.
  • Ensures all investigative findings are clearly tied to applicable company policies (e.g., Code of Conduct), federal and state regulations, and to maintain regulatory defensibility and support appropriate remediation.
  • Provides timely reports, both orally and in writing, to the Director of Ethics & Investigations and/or senior management regarding the status and outcomes of investigations.
  • Thoroughly documents, organizes, and reviews case files within centralized case management systems (e.g., Archer) in accordance with Company policy and CIU protocols.
  • Collaborates cross-functionally with other departments, including Legal, People Relations, SIU, Privacy, Finance, and Business Operations on investigations and the investigative process.
  • Prepares and analyzes departmental metrics, including investigation KPIs, case aging, and trending data, and makes recommendations accordingly.
  • Prepares presentations and presents findings to departmental and business management, executive leadership, and other stakeholders as needed.
  • Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks.
  • Performs follow-up to ensure remedial/disciplinary measures are implemented appropriately and timely, including tracking remediation activities through case management systems.
  • Assists with various projects as assigned by the Director of Ethics & Investigations or the VP of Compliance Investigations.
  • Performs other duties as assigned.
  • Complies with all policies and standards.


Education/Experience:
  • A Bachelor's Degree in Related Field or Associates with 5 years of applicable experience, or a High School/GED with 6 years of applicable experience may substitute for the Bachelor's Degree, required.
  • 4+ years of experience in investigations, auditing and risk analysis required.
  • 1+ year of experience in reading, analyzing and interpreting State and Federal laws, rules and regulations required.


Preferred Qualifications:
  • Managed care or health insurance company experience preferred.
  • Experience with compliance case management systems (e.g., Archer, Navex) preferred.
  • Demonstrated experience conducting ethics and compliance investigations in a regulated healthcare environment preferred.
  • Experience collaborating with cross-functional teams including Legal, People Relations, SIU, and Privacy preferred.


Licenses and Certifications:
  • Certified Fraud Examiner (CFE) preferred.
  • Certified Compliance & Ethics Professional (CCEP) or Certified Healthcare Compliance (CHC) preferred.


Pay Range: $70,100.00 - $126,200.00 per year

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.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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