Senior Manager, Sales Investigations

Job Description

As a Senior Manager, you'll be a subject matter expert, guiding managers to build a compliance-focused investigative team. You will provide enterprise-wide leadership for the Sales Investigations Team (SIT), overseeing day-to-day investigative operations. You will direct investigations of Medicare Advantage agent and agency misconduct allegations, including sales-related violations, fraud, waste, and abuse (FWA) concerns. You will establish and maintain investigation standards, protocols, and quality controls to ensure cases withstand scrutiny. You will leverage data analysis and trend interpretation to identify systemic issues and drive enterprise-level corrective action strategies. You will also oversee investigation-related policy and program frameworks and lead, coach, and develop multi-layer teams.

Qualifications

1. Bachelor's Degree in Compliance, Law, Criminal Justice, or a related field, or equivalent experience. 2. Master's Degree preferred. 3. Juris Doctor (JD) preferred. 4. 6+ years of experience in Compliance, investigations, law enforcement leadership, SIU, FWA, audit, and/or regulatory functions within managed care or a similar environment. 5. 2+ years of experience leading people leaders and/or multi-layer teams preferred. 6. Experience working with Medicare Advantage sales distribution structures required. 7. Experience working with Medicare Advantage sales distribution models, including first-tier, downstream, and related entity (FDR) structures required. 8. Licenses/Certifications: HCCA (CHC/CHPC), CFE, AHFI, CPCI, CPA, CIA, or other industry-related certification preferred.

Benefits

- Competitive pay - Health insurance - 401K and stock purchase plans - Tuition reimbursement - Paid time off plus holidays - Flexible approach to work with remote, hybrid, field, or office work schedules