Current jobs related to Senior Compliance Investigator - New York, New York - Centene

  • Compliance Nurse Investigator

    2 months ago

    New York, New York, United States MultiCare Health System, Inc. Full time

    Job Title: Compliance Nurse InvestigatorWe are seeking a highly skilled Compliance Nurse Investigator to join our team at MultiCare Health System, Inc.About the RoleThe Compliance Nurse Investigator will be responsible for conducting compliance audits and reviews, investigating alleged violations, and providing clinical expertise to review and analyze...

  • Senior Investigator Specialist

    1 week ago

    New York, New York, United States Constructive Partnerships Unlimited Full time

    Job Summary:Constructive Partnerships Unlimited seeks a skilled Senior Investigator Specialist to join our team. As a key member of our Incident Management team, you will be responsible for conducting thorough investigations into situations that may violate the rights and/or protections of individuals receiving services.Key Responsibilities:Assist the...

  • Senior Counsel, Investigations

    3 weeks ago

    New York, New York, United States Major League Baseball Full time

    Job Title: Senior Counsel, InvestigationsMajor League Baseball (MLB) is seeking a highly skilled and experienced Senior Counsel to join our Department of Investigations. As a key member of our team, you will play a critical role in assisting with confidential and sensitive investigations related to players, umpires, and baseball...

  • Senior Compliance Specialist

    3 weeks ago

    New York, New York, United States Klarna Full time

    Unlock Your Potential as a Senior Compliance Specialist at KlarnaKlarna, a leading fintech company, is seeking a highly skilled Senior Compliance Specialist to join our team. As a key member of our compliance team, you will play a critical role in ensuring the integrity of our financial systems and processes.Key Responsibilities:Support Money Laundering...

  • Surveillance Investigator

    1 month ago

    New York, New York, United States Allied Universal® Compliance and Investigations Full time

    Job OverviewAdvance your career in insurance claims with Allied Universal Compliance and Investigations. As a global leader in the industry, we offer dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our diverse and inclusive team is committed to innovation and excellence, making a significant impact in the...

  • Senior AML Investigator

    3 weeks ago

    New York, New York, United States RIT Solutions, Inc. Full time

    Job Title: Senior AML Investigator - EDD & PEPRIT Solutions, Inc. is seeking a highly skilled Senior AML Investigator - EDD & PEP to join our team. As a key member of our financial crimes team, you will be responsible for conducting complex investigations and providing expert analysis to support our clients' AML and sanctions compliance efforts.Key...

  • Senior Compliance Specialist

    2 weeks ago

    New York, New York, United States Klarna Full time

    Unlock Your Potential at KlarnaAs a global leader in fintech, Klarna is shaping the future of payments and financial services. We're seeking a highly skilled Senior Compliance Specialist to join our team and contribute to our mission of making payments faster, safer, and more convenient.Key Responsibilities:Support Money Laundering Reporting Officers in...

  • Global Financial Crimes Compliance Investigator

    3 weeks ago

    New York, New York, United States Bank of America Full time

    Job DescriptionAt Bank of America, we are committed to creating a workplace that is inclusive and diverse, where everyone has the opportunity to succeed. As a Global Financial Crimes Compliance Investigator, you will play a critical role in helping us achieve this goal.Key ResponsibilitiesConduct end-to-end investigations of external financial crimes...

  • Senior Team Leader

    2 weeks ago

    New York, New York, United States City of New York Full time

    Job SummaryWe are seeking a highly skilled and experienced Senior Team Leader to join our team as an Associate Fraud Investigator II. The successful candidate will be responsible for supervising a shift of investigators and social service employees, ensuring compliance with federal, state, and city regulations, and overseeing program unit, intake, and field...

  • Senior Fraud Investigator

    2 weeks ago

    New York, New York, United States City of New York Full time

    Job SummaryWe are seeking a highly skilled Senior Fraud Investigator to join our team at the City of New York. As a Senior Fraud Investigator, you will be responsible for conducting thorough investigations of documents submitted by IDNYC applicants, accessing various database resources, and verifying information of record.Key Responsibilities:Conduct complex...

  • Global Financial Crimes Compliance Investigator

    3 weeks ago

    New York, New York, United States Bank of America Full time

    Job Title: Global Financial Crimes Compliance InvestigatorThis role is responsible for conducting end-to-end investigations or investigations support functions of external financial crimes activities across one or more lines of business.Key Responsibilities:Conducting routine to complex investigations, including fraud committed by external parties, money...

  • Senior Investigative Analyst

    3 weeks ago

    New York, New York, United States City of New York Full time

    Job Title: Senior Investigative AnalystCompany DescriptionThe New York County District Attorney's Office is seeking a highly skilled Senior Investigative Analyst to join their team. As a key member of the investigative unit, you will play a critical role in supporting Assistant District Attorneys in building and enhancing complex cases and investigations.Key...

  • Senior Counsel, Investigations

    4 weeks ago

    New York, New York, United States Major League Baseball Full time

    Job Title: Senior Counsel, InvestigationsMajor League Baseball (MLB) is seeking a highly skilled and experienced Senior Counsel to join our Department of Investigations. As a key member of our team, you will play a critical role in assisting with confidential and sensitive investigations related to players, umpires, and baseball...

  • Senior Manager of Policy Compliance

    2 weeks ago

    New York, New York, United States City of New York Full time

    The City of New York is seeking a highly skilled Senior Manager of Policy Compliance to join the Office of Policy, Procedures, and Training. This role will be responsible for directing research, conducting high-level analysis, and managing the drafting of reports utilizing research methods and program evaluation techniques.The ideal candidate will have a...

  • Senior Investigative Attorney

    4 weeks ago

    New York, New York, United States MLB (Major League Baseball) Full time

    Job Title: Senior Counsel, InvestigationsMajor League Baseball (MLB) is seeking a highly skilled and experienced Senior Counsel to join our Department of Investigations. As a key member of our team, you will play a critical role in ensuring the integrity of the game by investigating allegations related to domestic violence, sexual assault, gambling,...

  • Senior Compliance Specialist

    2 weeks ago

    New York, New York, United States Michael Page Full time

    Senior Compliance Consultant RoleThe Senior Compliance Consultant will be responsible for ensuring regulatory compliance with FINRA, SEC, and broker-dealer regulations. This includes monitoring and implementing new regulatory developments, serving as the primary contact for regulatory inquiries and audits, and developing and updating compliance policies and...

  • Senior Hospital Care Investigator

    4 weeks ago

    New York, New York, United States NYC Health Hospitals Full time

    Job Title: Senior Hospital Care InvestigatorAt NYC Health + Hospitals, we are committed to delivering high-quality care and services to our patients. We are seeking a Senior Hospital Care Investigator to join our team.Job SummaryThe Senior Hospital Care Investigator will be responsible for supervising a unit of Hospital Care Investigators and conducting...

  • Senior Claims Investigator

    1 week ago

    New York, New York, United States City of New York Full time

    The City of New York is seeking a skilled Senior Claims Investigator to join its team in the Bureau of Law & Adjustment. As a key member of the Property Damage Division, you will be responsible for investigating and resolving tort claims filed against the City.Key responsibilities include:Conducting thorough investigations of property damage claims,...

  • Senior Fraud Investigator

    2 weeks ago

    New York, New York, United States City of New York Full time

    Job Summary:IDNYC is seeking a highly skilled Fraud Investigator II to function as Senior Program Integrity Specialist. This role will conduct thorough investigations of documents submitted by IDNYC applicants, access various database resources, and verify information of record.Key Responsibilities:Conduct complex investigations of documents submitted by...

  • Senior Investigative Analyst

    2 weeks ago

    New York, New York, United States City of New York Full time

    Job DescriptionThe City of New York is seeking a highly skilled Senior Investigative Analyst to join our team. As a key member of our investigative unit, you will work closely with Assistant District Attorneys to build and enhance complex cases and investigations.Your primary responsibilities will include:Assisting ADAs in developing long-term investigations...

Senior Compliance Investigator

2 months ago

New York, New York, United States Centene Full time
Transforming Healthcare: A Leadership Opportunity

Centene is revolutionizing the health of our communities, one person at a time. As a leader in our organization, you'll have access to competitive benefits, including a fresh perspective on workplace flexibility.

Job Summary:

Oversee a full range of waste, abuse, and fraud investigations, audits, and medical code editing scenarios. Ensure all audits adhere to federal and state Medicaid fraud, waste, and abuse guidelines.

Key Responsibilities:
  • Lead the activities of the SIU for accurate and timely operational reviews and final reviews
  • Interpret audit results and assist health plan executives in developing appropriate action plans to address identified risks
  • Develop and implement continuous auditing processes from analytic design to final report stage
  • Identify and direct the implementation of new technologies
  • Ensure compliance with all state and federal regulations for fraud and abuse
  • Respond to all legal inquiries, including subpoenas and court appearances
  • Attend federal CMS and state fraud meetings with other managed care organizations, and state and federal employees
Requirements:

Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management, or related field, or equivalent. 7+ years of related compliance and/or special investigation experience in managed care or CMS.

Please note: this is a remote position, however, due to contract requirements, this candidate must reside within the state of New York.

What We Offer:

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.