Compliance & Investigations Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Compliance & Investigations Manager based in the United States.

As a Compliance & Investigations Manager, you’ll play a key role in strengthening compliance, managing risk, and protecting the organization across diverse healthcare environments.

You’ll independently lead complex investigations involving compliance, privacy, billing, coding, operational, and risk-management concerns.

The role goes beyond case management, requiring deep analysis to uncover root causes, systemic vulnerabilities, and emerging risks.

You’ll partner with leaders across Compliance, Legal, Human Resources, Revenue Cycle, Operations, and Clinical teams to develop meaningful corrective actions.

Your work will help improve regulatory readiness, reduce organizational exposure, and strengthen operational and patient-safety outcomes.

You’ll also contribute to workers’ compensation claim investigations, liability assessments, case management, reporting, and legal proceedings.

This is a fully remote opportunity offering broad organizational visibility and the opportunity to make a measurable impact on healthcare compliance and risk management.

Accountabilities

• Conduct complex compliance, operational, privacy, billing, coding, and risk-management investigations across multiple healthcare settings.
• Manage cases originating from compliance hotlines, risk-management event reports, leadership referrals, regulatory concerns, internal audits, and other sources.
• Conduct witness and claimant interviews, review documentation, analyze evidence, and prepare detailed investigative reports and executive summaries.
• Ensure investigations are objective, thorough, confidential, timely, and consistent with organizational policies and regulatory requirements.
• Track and analyze investigation activity to identify recurring compliance, operational, fraud, and patient-safety risks.
• Perform detailed root-cause analyses to identify process failures, operational breakdowns, and systemic vulnerabilities.
• Develop actionable corrective action plans and risk-mitigation recommendations to reduce future exposure and improve operational performance.
• Partner with operational leaders and cross-functional teams to implement process improvements and monitor the effectiveness of mitigation strategies.
• Review allegations and event reports for potential regulatory, billing, coding, fraud, waste and abuse, HIPAA/privacy, and operational compliance concerns.
• Analyze healthcare billing and coding documentation to identify potential compliance or reimbursement risks.
• Support assessments of operational practices against CMS requirements, healthcare regulations, accreditation standards, and internal policies.
• Support regulatory-readiness activities and operational compliance reviews across outpatient, physician practice, ambulatory, rehabilitation, and hospital-based healthcare environments.
• Prepare executive-level findings, trend reports, risk analyses, recommendations, and other materials for leadership.
• Collaborate with Compliance, Risk Management, Revenue Cycle, Legal, Human Resources, Operations, and Clinical teams on investigations and corrective actions.
• Participate in organizational risk assessments, audits, and compliance initiatives.
• Support workers’ compensation claim investigations by reviewing injury reports, statements, incident documentation, and relevant claims history.
• Interview injured employees, supervisors, and witnesses to establish facts and assess potential liability.
• Serve as a liaison between injured employees, management, insurance carriers, third-party administrators, and legal teams.
• Coordinate return-to-work processes, including light-duty assignments and modified work plans, in collaboration with HR and safety personnel.
• Maintain accurate electronic case documentation, updates, diary dates, and milestones within risk-management systems.
• Complete required initial contacts and statutory filings within applicable legal deadlines.
• Gather and organize discovery materials and support legal counsel with hearings and case preparation.
• Attend mediations, settlement conferences, appeals-board hearings, and other legal proceedings when required.
• Analyze workers’ compensation claim trends and prepare reports that identify safety risks, recurring hazards, and potential cost-saving opportunities.

Requirements

• Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, Compliance, Legal Studies, or a related field.
• Minimum of 5 years of experience in healthcare compliance, healthcare investigations, risk management, auditing, revenue integrity, or a related healthcare regulatory function.
• Demonstrated ability to independently conduct complex healthcare investigations from intake through resolution and reporting.
• Strong analytical, investigative, interviewing, documentation, and problem-solving capabilities.
• Ability to identify systemic operational risks, determine root causes, and recommend practical corrective actions.
• Strong working knowledge of healthcare billing and coding practices.
• Knowledge of CMS regulations and healthcare regulatory requirements.
• Strong understanding of HIPAA and healthcare privacy requirements.
• Knowledge of fraud, waste, and abuse concepts and related compliance risks.
• Understanding of healthcare operational workflows and risk-management practices.
• Experience working across multiple healthcare environments, such as outpatient clinics, physician practices, hospital-based departments, ambulatory care, or rehabilitation services.
• Excellent written and verbal communication skills, with the ability to produce clear investigative documentation and executive-level reporting.
• Strong interviewing skills and the ability to evaluate conflicting information objectively.
• Ability to handle sensitive and confidential information with discretion and professionalism.
• Strong organizational skills and the ability to manage multiple investigations, cases, deadlines, and priorities independently.
• Ability to collaborate effectively with senior leaders and cross-functional teams, including Legal, HR, Compliance, Revenue Cycle, Operations, and Clinical stakeholders.
• Sound judgment, intellectual curiosity, attention to detail, and a proactive approach to identifying emerging risks.

Benefits

• Annual salary of $90,000-$95,000, with actual compensation determined by factors such as experience, background, and work location.
• Fully remote position within the United States.
• Opportunity to work across multiple healthcare environments and functional areas.
• Broad exposure to healthcare compliance, investigations, operational risk, regulatory readiness, and workers’ compensation.
• Opportunity to influence corrective actions, process improvements, and enterprise risk-reduction strategies.
• High-visibility role involving collaboration with operational leaders and senior cross-functional stakeholders.
• Opportunity to contribute to initiatives that strengthen regulatory compliance, operational performance, and patient safety.
• Professional environment focused on quality, accountability, collaboration, and continuous improvement.