Compliance Investigator Associate

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.
 

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

Position Purpose: Position investigates and remediates compliance related matters of lower complexity. Supports senior level investigators with complex investigations and assists with internal and external reporting.

• Ensures adherence to compliance with established standards, policies and procedures.
• Evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare & Medicaid Services (“CMS”) guidelines, and internal policies, procedures, and standards that are alleged to have been violated.
• Prepares and performs review of departmental and company metrics.
• Conducts interviews with beneficiaries, sales agents, providers, associates, and/or downstream entities as required for investigatory purposes.
• Identifies risks and recommends remedial actions to mitigate future potential risks.
• Prepares clear and concise draft investigative plans and reports.
• Supports the planning, development, and coordination of multiple projects, including prioritizing and managing through execution.
• Thoroughly documents and organizes case files, electronic and hard copy, relative to each investigation in accordance with Company / departmental policy and ensures remediation activities are tracked and implemented.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Required A Bachelor's Degree in Related Field or: Required Other Associates with 2 years of applicable experience, or a High School/GED with 4 years of applicable experience may substitute for the Bachelors Degree

Candidate Experience:

• Required 1+ year of experience in investigator or loss prevention related role.
• Required 4+ years of experience in or customer service, appeals, grievance or related field.
• Required Other or successful completion of 12 weeks WellCare internship program.

Preferred Other Healthcare or related industry:

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.  Total compensation may also include additional forms of incentives.

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