Sr. Manager, Auditing

Central Health•Austin, TX

About The Position

The Senior Manager, Auditing, Monitoring & Vendor Oversight is responsible for providing independent, second-line oversight and assurance over Sendero Health Plan’s compliance with federal and state regulatory requirements applicable to a Qualified Health Plan. This role evaluates whether compliance controls—implemented and maintained by operational areas and supported by the Senior Manager, Compliance—are designed effectively and operating as intended. The Senior Manager, Auditing, Monitoring & Vendor Oversight conducts risk-based compliance monitoring, auditing, and vendor oversight activities, validates corrective actions, and identifies systemic compliance risks. This role works in close coordination with the Senior Manager, Compliance, while maintaining appropriate independence to support objective findings, credible escalation, and regulatory defensibility under the Affordable Care Act (ACA), Centers for Medicare & Medicaid Services (CMS) Marketplace regulations, and Texas Department of Insurance (TDI) requirements.

Requirements

Bachelor's Degree (higher degree accepted) in healthcare administration, business, accounting, law, or a related field.
6 years years of experience in healthcare compliance monitoring, auditing, risk management, or vendor oversight.
Working knowledge of ACA, CMS Marketplace, Medicaid requirements, and Texas Department of Insurance regulatory frameworks.
Experience conducting compliance monitoring or audits in regulated healthcare environments.
Strong analytical, investigative, and documentation skills.
Risk based compliance monitoring and auditing
Independent judgment and objectivity
Vendor and delegated entity oversight
Root cause analysis and validation
Clear reporting and escalation
Cross functional collaboration

Responsibilities

Execute risk based compliance monitoring and audit activities in accordance with approved methodologies and annual work plans.
Independently assess compliance controls across internal operations and vendor managed functions.
Conduct reviews across key operational areas, including: Enrollment and eligibility, Claims processing and payment accuracy, Appeals and grievances, Marketing and broker oversight, Privacy and information security, Delegated and downstream entities.
Maintain complete, accurate, and defensible audit documentation and workpapers.
Identify control weaknesses, compliance gaps, and regulatory risks through monitoring and audit activities.
Perform independent root cause analysis and assess risk severity.
Escalate significant findings in accordance with compliance governance and risk management protocols.
Independently validate corrective actions implemented by business units and coordinated by the Senior Manager, Compliance.
Conduct follow up testing to confirm remediation effectiveness and sustainability.
Support evidence based issue closure decisions.
Conduct compliance monitoring and audit reviews of vendors and delegated entities.
Assess vendor adherence to contractual, regulatory, and documentation requirements.
Identify vendor related risks and systemic issues and communicate findings to Compliance leadership and Vendor Management.
Validate vendor remediation efforts following identified findings.
Support CMS, TDI, and other regulatory audits or examinations through independent oversight and documentation.
Provide objective assessments during regulatory reviews without assuming operational ownership of responses.
Identify audit trends and lessons learned to inform future monitoring activities.
Coordinate closely with the Senior Manager, Compliance to ensure clarity of roles and responsibilities.
Share findings, trends, and risk insights to support operational remediation efforts.
Maintain independence by refraining from designing, implementing, or owning compliance processes.
Prepare monitoring and audit reports summarizing findings, risk levels, and remediation status.
Provide periodic reporting to compliance leadership on trends, recurring issues, and vendor performance.
Support leadership reporting to governance committees as requested.