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Senior Health Plan Auditor

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Bright Vision Technologies

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Location:
United States , Los Angeles

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Category:
Finance

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

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.

Job Responsibility:

  • 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

Requirements:

  • Bachelor’s Degree in Accounting or a related field (required)
  • 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
  • Must hold one of the following certifications: Certified Public Accountant (CPA), Certified Management Accountant (CMA), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE)
What we offer:
  • Equal employment opportunities
  • Inclusive work environment
  • Accommodations during recruitment process

Additional Information:

Job Posted:
January 16, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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