Manager, Sales Investigations

Role Overview

• Leads day-to-day operations for a team of Sales Investigators and Senior Sales Investigators responsible for investigating allegations of sales agent, agency, broker, and related sales-practice misconduct.
• Serves as the first-line people leader accountable for risk-based case assignment, investigative quality, timeliness, and consistent application of established standards.
• Ensures investigative work is documented in a clear, complete, and defensible manner and that team outputs are aligned with internal policies, CMS requirements, and audit/regulatory expectations.
• Partners with Compliance leadership, Legal, Sales, HR, and other stakeholders to address case-specific issues, implement corrective actions, and escalate systemic or high-risk concerns.
• Directly manages, coaches, and develops investigators and senior investigators; supports hiring, onboarding, performance management, and skills development to build and sustain a high-performing investigative team.
• Assigns and rebalances caseloads based on risk, complexity, investigator capability, and regulatory time sensitivity; monitors workflow to ensure timely completion of investigations and appropriate prioritization of higher-risk matters.
• Oversees day-to-day investigative execution for the team, including intake-to-closure progress, adherence to investigative protocols, and consistent use of approved templates, procedures, and documentation standards.
• Conducts formal quality review of investigative plans, evidence documentation, interview records, analysis, findings, and written reports; identifies deficiencies, provides coaching, and ensures work product meets established defensibility, accuracy, and completeness standards.
• Serves as the primary management escalation point for complex, sensitive, novel, or gray-area matters; reviews case direction and conclusions to promote consistent, risk-based application of standards and appropriate escalation of matters requiring senior leadership review.
• Ensures team members correctly apply relevant Medicare Advantage, Marketplace, Medicaid, and related sales conduct requirements, including CMS-aligned guidance and internal policy expectations; identifies competency gaps and coordinates targeted training and reinforcement.
• Partners with Legal, Compliance, HR, Sales Operations, and business leaders to coordinate interviews, obtain records, validate facts, align on remediation, and support appropriate corrective and disciplinary actions.
• Tracks and reports operational and quality metrics, including case volume, timeliness, aging, quality trends, outcomes, and remediation follow-through; identifies recurring issues, emerging patterns, or control weaknesses and escalates systemic risk concerns to senior leadership.
• Reinforces disciplined case documentation, evidence organization, and file maintenance practices to support audit readiness, regulatory response, and consistent retention of investigative records.
• Supports implementation and continuous improvement of job aids, workflows, templates, and team procedures that promote consistency, effectiveness, and defensibility in investigative operations.
• Prepares or supports materials needed for audits, regulatory inquiries, internal oversight reviews, and management reporting by ensuring case records are complete, accessible, and supportable.
• Promotes a culture of sound investigative judgment, accountability, consistency, and continuous improvement within the team.

Requirements

• A Bachelor's Degree in Criminal Justice, Law, Compliance, Healthcare Administration, or related field required OR Associates with 6 years of applicable experience, OR a High School/GED with 7 years of applicable experience
• 5+ years of progressive experience in compliance, investigations, SIU, FWA, audit, or related functions in managed care, healthcare, or another similarly regulated environment required
• 1+ year of experience in leading or managing others required
• Demonstrated experience reviewing investigative work product for quality, evidentiary sufficiency, and defensibility required
• Demonstrated experience coordinating cross-functional case activity and remediation with business stakeholders required
• Preferred Qualifications: 2+ years of direct people leadership,
• Managed care or health plan experience
• Experience supporting audit responses, regulatory inquiries, or oversight reviews
• Working knowledge of Medicare sales and marketing compliance expectations, including CMS Chapter 42 and related CMS marketing guidance
• Professional certification such as CFE, AHFI, CIA, CHC/HCCA, CCP, or similar

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