Senior Compliance Investigator

Role Overview

• Under the general direction of the VP of Compliance Investigations, assist with the development, implementation, and continuous monitoring of an enterprise-wide Compliance Investigations Program
• Lead and oversee compliance and ethics investigations
• Facilitate and lead meetings with business management and cross-functional stakeholders
• Prepare, review, and analyze internal and external reporting
• Conduct compliance and ethics investigations across all business units and health plans, including assessment of allegations, review of relevant documents, witness interviews, analysis of facts, root cause analysis
• Prepare investigation reports with recommended remedial or disciplinary actions
• Provide weekly case summaries and adhere to established minimum case review quotas
• Provide 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 document, organize, and review case files within centralized case management systems (e.g., Archer) in accordance with company policy and CIU protocols
• Collaborate cross-functionally with other departments

Requirements

• 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
• 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
• Certified Fraud Examiner (CFE) preferred
• Certified Compliance & Ethics Professional (CCEP) or Certified Healthcare Compliance (CHC) 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