Senior Compliance Investigator

Overview

A prominent healthcare organization is looking to hire a Senior Compliance Investigator to enhance and support its enterprise-wide compliance investigations program. This role involves leading complex compliance and ethics investigations across various business units, health plans, and corporate functions.

Key Responsibilities

• Lead and execute thorough compliance and ethics investigations, assessing allegations and applying relevant regulatory and policy standards.
• Review documentation, conduct witness interviews, analyze facts, and perform root cause analyses to ascertain compliance issues.
• Prepare detailed investigation reports recommending remedial or disciplinary actions based on findings.
• Ensure all investigative outputs are aligned with company policies, codes of conduct, laws, and regulations.
• Handle investigations systematically following established plans and timelines, maintaining a balanced caseload with timely resolutions.
• Research and interpret federal and state laws to identify compliance risks and their potential organizational impacts.
• Evaluate investigative results to suggest corrective measures and preventive strategies to mitigate future risks.
• Monitor the implementation of remediation and disciplinary actions, ensuring compliance with timelines.
• Maintain detailed, organized case files within centralized case management systems and provide regular status updates to leadership.
• Prepare and communicate internal and external reports, analyze metrics and trends, and present findings to executives and stakeholders.
• Collaborate extensively with Legal, People Relations, Special Investigations, Privacy, Finance, and Business Operations teams throughout the investigative process.
• Drive continuous improvement of the compliance investigations program, identifying opportunities to enhance processes, controls, and risk management.
• Adhere to applicable policies, procedures, and professional standards while supporting related compliance, ethics, and risk initiatives.

Qualifications and Experience

• Bachelor's degree or equivalent in a related field.
• Minimum of four years' experience in investigations, auditing, risk analysis, or related areas.
• At least one year of experience applying federal and state regulatory requirements.
• Proven analytical, investigative, and problem-solving capabilities.
• Experience in structured investigations and thorough documentation of findings.
• Ability to manage numerous cases and competing priorities under deadlines.
• Excellent written and verbal communication skills for explaining complex issues to diverse audiences.
• Strong attention to detail and sound judgment.

Preferred Qualifications

• Experience in managed care, health insurance, healthcare, or other regulated settings.
• Familiarity with ethics and compliance investigations.
• Proficient with compliance case management software such as Archer or NAVEX.
• Experience working collaboratively with teams like Legal, People Relations, Special Investigations, Privacy, Finance, and Business Operations.
• Certifications such as Certified Fraud Examiner (CFE), Certified Compliance & Ethics Professional (CCEP), or Certified Healthcare Compliance (CHC) are advantageous.

Compensation and Benefits

The expected yearly salary ranges from 70100 to 126200, influenced by background, skills, and qualifications. The role may also include benefits like health coverage, retirement plans, stock purchase options, paid leave, holidays, tuition reimbursement, and flexible work arrangements.

Work Environment

This position supports remote work but may require hybrid, field, or office settings depending on business needs.