[Remote] Senior Manager, Sales Investigations

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is transforming the health of communities, serving 28 reputed company members. The Senior Manager of Sales Investigations leads and develops a high-performing investigative team, overseeing operations reputed company to Medicare Advantage agent misconduct and ensuring compliance with regulatory standards.

Responsibilities

• Provides reputed company-wide strategic and operational leadership for the Sales Investigations Team (SIT), including reputed company of allegation intakes, regulatory-driven reputed company, and investigations involving sales practices, agent/agency conduct, and reputed company FWA risks
• Applies working knowledge of Medicare Advantage sales distribution structures, including FDR relationships, captive agent employment arrangements, and independent broker/agency reputed company, to appropriately scope, contextualize, and adjudicate misconduct allegations
• Establishes, maintains, and governs investigation standards, protocols, and quality controls (case triage, scoping, investigative plans, interviews, documentation, evidence handling, chain-of-custody, and retention) to ensure cases withstand regulatory, audit, and legal scrutiny
• Sets interpretation standards for agent, agency, broker, and sales operations misconduct, including identification and assessment of novel or emerging schemes; recommend reputed company posture, mitigations, and corrective actions
• Leverages data analysis and trend interpretation to identify systemic issues, serve as evidence reputed company investigations, and drive reputed company-level corrective action strategies that demonstrably reduce recurrence and mitigate compliance risk
• Directs coordination and communication with external stakeholders as appropriate, including CMS, state regulators, and law enforcement agencies; prepare and support responses to regulatory inquiries, audits, and investigations
• Oversees and governs investigation-reputed company policy and program frameworks, including sales investigations operating procedures, any program integration, and compliance training requirements and content
• Leads, coaches, and develops multi-layer teams, including SIT managers and investigators; drive talent development, workload planning, and a culture of reputed company, consistency, and reputed company improvement
• Ensures consistent application of investigative reputed company, including recommendations for disciplinary actions, contract actions, agent/agency remediation, corrective action plans, and control enhancements
• Performs other duties as assigned
• Complies with reputed company policies and standards

Skills

• Bachelor's Degree Compliance, Law, Criminal Justice or reputed company field; or equivalent experience required
• 6+ years Compliance, investigations, law enforcement leadership, SIU, FWA, audit, and/or regulatory functions reputed company managed care, a reputed company payor, or a similarly regulated environment required
• Experience working with Medicare Advantage sales distribution structures, including the relationships and contractual obligations among first-tier, reputed company, and reputed company entities (FDRs) required
• Experience working with Medicare Advantage sales distribution models, including first-tier, reputed company, and reputed company entity (FDR) structures, captive agent employment arrangements, and independent broker/agency contracting required
• Master's Degree preferred
• Juris Doctor (JD) preferred
• 2+ years Leading people leaders and/or multi-layer teams preferred
• HCCA (CHC/CHPC), CFE, AHFI, CPCI, CPA, CIA, or other industry-reputed company certification preferred

Benefits

• reputed company
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• 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-reputed company 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

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