Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. Centene offers affordable and high-quality products to more than 1 in 15 individuals across the nation, including Medicaid and Medicare members as well as individuals and families served by the Health Insurance Marketplace.

Centene believes healthcare is best delivered locally. Our local health plans provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals.

Centene’s hiring practices reflect the composition of the members and communities we serve, allowing us to deliver quality, culturally sensitive healthcare to millions of members. Centene employees help change the world of healthcare and transform our communities.

Centene Corporation

Transforming the health of the communities we serve, one person at a time.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Responsible for leading and managing the most complex, sensitive, and high-impact internal investigations across the organization. Serves as a strategic advisor and subject matter expert on investigative best practices, regulatory compliance, and risk mitigation. Requires exceptional judgment, discretion, and the ability to influence senior leadership decisions while ensuring adherence to federal and state regulations, internal policies, and ethical standards.

Consults with management, in-house counsel, and/or the Director of Corporate Compliance as needed to resolve difficult, highly sensitive or complex compliance issues.Independently evaluates and assesses allegations to determine whether domestic laws, regulatory policies, or internal policies, procedures, and standards have been violated.Plans, scopes, and conducts complex, confidential internal investigations from inception to conclusion. This includes defining investigation strategy, preserving evidence, conducting interviews, analyzing records, conducting root cause analysis, and recommended corrective and disciplinary actions.Conducts, manages, and documents interviews with witnesses, as required for investigatory purposes.Reviews investigation reports prepared by junior investigators.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.Plans, develops, leads, and manages multiple projects, including prioritizing and managing through execution.Maintains meticulous case files and chronologies in accordance with best practices.Thoroughly documents, organizes, and reviews case files, electronic and hardcopy, relative to each investigation in accordance with Company policy and ensures remediation activities are tracked and implemented.Prepares clear and concise draft investigation plans and reports.Provides support and guidance to junior investigation staff as applicable.Attends, actively participates in, and/or leads meetings with various business area managers.Communicates directly with Federal or State regulators.Supports the development and maintenance of Corporate Compliance policies and procedures and workflows.Participates in and leads special projects (e.g., auditing, training, and HIPAA compliance).Provides support of and guidance to other associates.Performs other duties as assigned.Complies with all policies and standards.

Education/Experience: Bachelor's Degree Criminal Justice/Criminology, Law, Healthcare Administration/Health Policy, or related field, equivalent experience required. Juris Doctorate highly preferred. 7+ years progressive experience in conducting and managing complex investigations or auditing and risk analysis required. 7+ years experience reading, analyzing and interpreting State and Federal laws, rules and regulations required. Prosecutorial experience preferred. Previous experience as an investigator within a large corporation or Federal Agency preferred.

Licenses/Certifications

Certified Fraud Investigator preferred

Pay Range: $107,700.00 - $199,300.00 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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Corporate Ethics & Compliance Investigator

What the job involves