Senior Health Plan Auditor
About The Position
Bright Vision Technologies is a forward-thinking software development company dedicated to building innovative solutions that help businesses automate and optimize their operations. We leverage cutting-edge technologies to create scalable, secure, and user-friendly applications. As we continue to grow, we’re looking for a skilled Senior Health Plan Auditor to join our dynamic team and contribute to our mission of transforming business processes through technology. This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential. The Senior Health Plan Auditor is responsible for planning, executing, reporting, and monitoring corrective action plans related to financial solvency and claims processing compliance for specialty health plans and vendors. This role ensures compliance with regulatory requirements and contractual agreements across all lines of business. The position also serves as a subject matter expert and mentor, supporting junior staff and contributing to process improvements and regulatory readiness.
Requirements
- Bachelor’s Degree in Accounting or a related field (required)
- Equivalent education and/or experience may be considered in lieu of degree
- Minimum 3 years of experience conducting financial audits
- Minimum 5 years of experience in the managed healthcare industry
- At least 2 years of accounting experience
- Strong analytical and critical-thinking skills
- Excellent verbal and written communication abilities
- Ability to work independently with minimal supervision
- Strong organizational and prioritization skills
- Professional communication with internal and external stakeholders
- Proficiency in Microsoft Excel, PowerPoint, and SharePoint
- Action-oriented, self-motivated, and detail-focused
- Certified Public Accountant (CPA)
- Certified Management Accountant (CMA)
- Certified Internal Auditor (CIA)
- Certified Fraud Examiner (CFE)
Responsibilities
- Perform financial audits and analyses for specialty health plans and vendors
- Conduct claims processing audits to ensure regulatory and contractual compliance
- Ensure timely and accurate audit deliverables related to financial solvency
- Support quarterly and annual DMHC claims data submissions
- Serve as liaison for CMS claim audits related to L.A. Care delegates
- Monitor, track, and report corrective action plans and non-compliance notices
- Assist in developing standardized audit workpapers and reporting templates
- Maintain and annually update departmental Policies & Procedures (P&Ps)
- Support legal, delegation oversight, and regulatory requests
- Collaborate with internal departments, leadership, vendors, and plan partners
- Identify opportunities for process improvement and technical solutions
- Provide training, mentorship, and guidance to junior staff and interns
- Participate in special projects and regulatory impact assessments
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
