Senior Compliance Investigator (Healthcare)

Location: Remote-MO

Salary: $70,100–$126,200 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members through its health plans and business units.

What you will do

• Lead and conduct compliance and ethics investigations, including allegation assessment, document review, witness interviews, fact analysis, root cause analysis, and investigation reporting.
• Evaluate alleged violations against federal and state regulations, the hirify.global Code of Conduct, and internal policies and procedures.
• Maintain investigation workplans, protocols, timelines, case files, and weekly case summaries in centralized systems such as Archer.
• Report investigation status and outcomes to the Director of Ethics & Investigations, the VP of Compliance Investigations, senior management, and executive stakeholders.
• Analyze investigation KPIs, case aging, and trends; identify risks and recommend remedial or disciplinary actions.
• Coordinate with Legal, People Relations, SIU, Privacy, Finance, and Business Operations and track remediation through completion.

Requirements

• Bachelor’s degree in a related field, or an equivalent combination of an associate degree and 5 years of experience or a high school diploma/GED and 6 years of applicable experience.
• At least 4 years of experience in investigations, auditing, and risk analysis.
• At least 1 year of experience reading, analyzing, and interpreting state and federal laws, rules, and regulations.
• Experience preparing investigation reports, presentations, metrics, and recommendations for management stakeholders.

Nice to have

• Managed care or health insurance experience.
• Experience with compliance case management systems such as Archer or Navex.
• Experience conducting ethics and compliance investigations in a regulated healthcare environment.
• Certified Fraud Examiner (CFE), Certified Compliance & Ethics Professional (CCEP), or Certified Healthcare Compliance (CHC) certification.

Culture & Benefits

• Remote work with a flexible approach that also supports hybrid, field, or office schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Compensation is adjusted based on skills, experience, education, and other job-related factors.
• Equal opportunity employment and consideration under applicable fair-chance hiring laws.