SR Health Plan Auditor
12 days ago
Los Angeles
Job DescriptionPrimary Job Title: Senior Health Plan Auditor Location: CA (Hybrid) Date Posted: 7/16/2025 Employment Type: 3-month Contract Salary Range: $50.53 - $55.53/Hr Job SummaryThe Senior Health Plan Auditor is a hybrid role and is responsible for all aspects of planning, execution, reporting, and corrective action plans, monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. These audits are intended to ensure that Client delegates are in compliance with regulatory requirements and Client contractual agreements across all lines of business.The position is responsible for the DMHC claims data submissions for Client and its Plan Partners and delegates each quarter and annually.Primarily responsible for the creation, review, and submission of departmental policies and procedures annually.Serves as a subject matter expert and mentor for other staff.Duties • Performs financial audits and/or financial analyses for Specialty Health Plans., • Performs financial analyses or vendor management for Client vendors., • Performs claims audits for Specialty Health Plans and vendors., • Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors., • Assists in the creation and implementation of standardized Specialty Health Plans and vendors' workpapers and reporting templates., • Responsible for the documentation and maintenance of the Financial Compliance Department's policies and procedures., • Responsible for the collection and completion of the quarterly and annual Department of Managed Health Care (DMHC) filing submissions., • Being cross-trained on financial solvency reviews for PPGs, PPs, and capitated hospitals., • Serves as primary contact and liaison for the Centers for Medicare and Medicaid Services (CMS) claim audit section of delegates., • Annually reviews and updates the department's Policies and Procedures (P&Ps). Ensures that any new or updated Policy and Procedure is reviewed and approved by management prior to submission., • Accountable for the completion of requests from the Legal Department, Delegation Oversight's monitoring, oversight and reporting., • Serves as a subject matter expert in assigned areas and cross-training initiatives., • Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, specialty health plans, and vendors., • Supports the design, implementation, and reporting of special projects., • Supports the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications., • Supports the assessment, communication, and implementation of regulatory requirements that may impact internal processes., • Supports the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development., • Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge., • Provides training, recommends process improvements, and mentors junior-level staff, department interns, etc. as needed., • Performs other duties as assigned.Education Required, • Bachelor's Degree in Accounting or Related Field, • In lieu of degree, equivalent education and/or experience may be considered.Experience Required, • At least 3 years of experience in conducting financial audits., • At least 5 years of related experience in the managed health care industry., • Minimum of 2 years of accounting experience.Skills Required, • Strong analytical and critical thinking skills., • Action-oriented, self-starter, and excellent motivator., • Excellent verbal and written communication skills., • Able to prioritize assignments and able to work independently with minimal supervision., • Ability to interface professionally with both internal and external customers at all levels of the organization., • Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).Licenses/CertificationsMust hold one of the following certifications:, • Certified Public Accountant (CPA), • Certified Management Accountant (CMA), • Certified Internal Auditor (CIA), • Certified Fraud Examiner (CFE)Contract Benefits, • Medical, Vision, and Dental Insurance Plans We are a Native American-owned, economically disadvantaged corporation that highly values diverse and inclusive workplaces. Our clients and partners are among the most successful and innovative organizations in the world. Our top clients are Fortune 500 banking, insurance, and financial services firms, some of the nation’s largest life sciences, biotech, utility, and retail companies, and prestigious educational institutions in the Ivy League tier. There is always a new opportunity for success when you look through all of the open job opportunities on our website’s career page. Just click on this link: Awards SIA’s Fastest Growing Staffing Firm: 2023 and 2015 SIA’s Best Staffing Firm to Work for: 2019 -2023 Inc 5000 Fastest Growing Private Company: 2023, 2022, 2016, 2015 Randstad Preferred Supplier: 2020 - 2023 TechServe Alliance Excellence Award. 2019 NH Business Magazines Fast 5 fastest growing companies Ernst & Young Entrepreneur of the Year Finalist: 2015Global Technical Talent is a subsidiary of Chenega Corporation () with over 1.3 billion US$ in revenue and 5800 US employees. We provide Total Talent Solutions, Global staffing, SOW, RPO, Direct Sourcing, and Global Payroll with physical offices in US, Canada, and India. GTT Digital headquartered in Toronto specializes in providing high-tech digital and banking talent to some of the nation’s largest financial institutions. As a leader in the staffing industry for over 22 years, we have become one of the largest staffing firms in the New England region, working with Fortune 500 clients and cutting-edge, technology-driven recruiting infrastructure.\r\n\r\nWe are a Native American-owned, economically disadvantaged corporation that highly values diverse and inclusive workplaces. Our clients and partners are among the most successful and innovative organizations in the world. Our top clients are Fortune 500 banking, insurance, and financial services firms, some of the nation’s largest life sciences, biotech, utility, and retail companies, and prestigious educational institutions in the Ivy League tier.\r\n \r\nThere is always a new opportunity for success when you look through all of the open job opportunities on our website’s career page. Just click on this link: \r\n \r\nAwards\r\n\r\nSIA’s Fastest Growing Staffing Firm: 2023 and 2015\r\nSIA’s Best Staffing Firm to Work for: 2019 -2023\r\nInc 5000 Fastest Growing Private Company: 2023, 2022, 2016, 2015\r\nRandstad Preferred Supplier: 2020 - 2023\r\nTechServe Alliance Excellence Award. 2019\r\nNH Business Magazines Fast 5 fastest growing companies\r\nErnst & Young Entrepreneur of the Year Finalist: 2015