Serves as a strategic leader overseeing all enterprise-wide sales investigations, with a primary focus on Medicare sales
Leads a high-performing investigation team responsible for examining allegations of non-compliant or fraudulent sales practices involving agents and agencies
Ensures all investigative activities align with federal and state regulations, internal policies, and ethical standards, safeguarding the integrity of the organization's sales operations
Develop and execute the enterprise-wide strategy for sales investigations, ensuring timely, accurate, and consistent resolution of cases
Lead, mentor, and develop a team of investigators, ensuring alignment with company values, business priorities, and compliance expectations
Direct investigations into potential sales misconduct, fraud, misrepresentation, or non-compliant practices; oversee root cause analyses and corrective action planning
Ensure investigative practices comply with CMS, state insurance departments, and other regulatory bodies
Partner and build strong relationships with Compliance, Legal, HR, and Medicare plan and Sales leadership to mitigate risk and address systemic issues uncovered during investigations
Provide executive-level reporting on investigation outcomes, trends, and risks; advise senior leadership on proactive risk management strategies
Continuously evaluate and enhance investigative methodologies, tools, and training to ensure best-in-class processes
Manage vendor and contractor relationships to ensure compliance with contracts and effective delivery of services supporting the Sales Investigations team
Develop preventative strategies, including controls, monitoring, and training, to reduce recurrence of sales-related issues
Serve as a trusted advisor to senior leadership on ethical sales practices and reputational risk
Performs other duties as assigned
Requirements
Bachelor’s degree compliance, legal studies, related field or equivalent experience required; master’s degree or Juris Doctor (JD) preferred
7+ years progressive experience in investigations, compliance, sales oversight, or regulatory affairs within healthcare, insurance, or managed care required
5+ years management experience managing investigative, sales operations or compliance team required
Strong understanding of Medicare product sales practices, CMS regulations, and Medicare guidelines required
Proven ability to handle complex, sensitive investigations with discretion and integrity required
Exceptional analytical, communication, and problem-solving skills required
Demonstrated ability to influence senior executives and collaborate across functions required.
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
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