Senior Internal Auditor

Job not on LinkedIn

🕒 April 21

🏄 California – Remote

🏄 California – Remote

💵 $24 - $28 / hour

⏰ Full Time

🟠 Senior

🔎 Auditor

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Jobs for Humanity

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2020

🤝 B2B

📚 Education

🎯 Recruiter

B2B • Education • Recruitment

Jobs for Humanity is an organization dedicated to promoting diversity and inclusion in the workforce by connecting underrepresented job seekers with employers. They focus on providing resources and training to enhance the hiring experience for individuals from marginalized groups, including those with disabilities, veterans, and minority communities. By facilitating equitable job opportunities, Jobs for Humanity aims to unlock untapped potential in the job market and foster inclusive hiring practices.

📋 Description

• Audit and analyze claims data to ensure processing accuracy and service-level standards are met at individual, group, and enterprise levels. • Review claims processing, specialty referrals, prior authorizations, benefit plans, group setup, and system configuration to confirm alignment with contracts and policies. • Validate benefit schedules, frequency limits, and provider compensation schedules to ensure accurate system configuration and payments. • Create and maintain claims and UM client file packets used for external audits and internal reviews. • Support CMS ODAG and CMS Part C audits, including file preparation, tracking, and data validation activities. • Analyze audit results, identify trends, and document findings to support training, calibration, and continuous improvement efforts. • Collaborate with Claims, UM, Compliance, IT, and other departments to follow up on audit findings and ensure timely corrections. • Support and test automation tools and internal bots to help meet regulatory and client requirements. • Assist with departmental reporting, training activities, and the development or refinement of audit policies and procedures. • Maintain professionalism and confidentiality when handling sensitive audit information. • Perform additional duties as assigned.

🎯 Requirements

• Preferred Bachelor’s degree or equivalent combination of education and relevant experience • Minimum 2 years of experience in claims processing, claims auditing, or claims data analysis (Dental PPO or DHMO environment strongly preferred) • 1+ year of internal audit experience, preferably within a dental or healthcare setting • Strong understanding of dental claims processing and audit methodologies • Proficiency in Microsoft Word and Excel • Strong analytical, reporting, and trend-analysis skills • Excellent attention to detail and comfort working with complex data • Ability to work independently while managing multiple priorities • Strong written and verbal communication skills • Discretion and professionalism when handling confidential information • Collaborative mindset with the ability to promote teamwork across departments

🏖️ Benefits

• Competitive pay structure and savings options to help you reach your financial goals. • Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines. • Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan. • 100% employer-paid dental coverage for employees and eligible dependents. • Vision insurance with low-cost premiums for employee-only coverage and dependents. • Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage. • Flexible Spending Accounts for healthcare and dependent care expenses. • Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. • Long-term disability coverage. • Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts. • Employee Assistance Program (EAP) to support mental health and well-being. • Generous vacation and sick leave policies, with the ability to roll over unused time. • 10 paid company holidays. • Tuition reimbursement for eligible educational expenses.