Compliance Auditor

Community Health Plan of Imperial Valley; California; On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Paid life and disability insurance

Retirement plan with generous match

Paid time off

Job summary

Community Health Plan of Imperial Valley is seeking a Compliance Auditor to review internal and delegated functions for compliance, identify systemic issues, and monitor regulatory metrics. The role includes auditing non-clinical areas like claims, credentialing, and language services, and ensuring timely, accurate reporting.

You will verify adherence to regulatory requirements (DHCS, DMHC, CMS, NCQA) and collaborate across departments to close gaps and support audit readiness.

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Business, or related field.
• 3–4 years of experience in compliance, auditing, or regulatory oversight within a managed care or healthcare delivery environment.
• Familiarity with Medi-Cal and/or Medicare regulatory requirements (DHCS, DMHC, CMS).
• Strong understanding of delegated functions such as claims, encounters, credentialing, and language assistance services.
• Demonstrated ability to review and interpret policies, procedures, and operational workflows.
• Excellent organizational, analytical, and time management skills with the ability to manage multiple priorities.
• Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and experience working with audit tracking systems or similar tools.

Responsibilities

• Evaluate process compliance and operational workflows for internal and delegated functions.
• Identify systemic issues and contribute to corrective action planning.
• Monitor regulatory metrics and reporting to committees.
• Conduct audits of non-clinical delegated functions including claims, encounters, credentialing, language assistance services, and program effectiveness.
• Review and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and materials.
• Assess compliance with DHCS, DMHC, CMS, and NCQA regulatory requirements, as well as contractual obligations.
• Identify gaps in documentation, workflows, and performance that could result in audit findings or compliance risks.
• Monitor corrective action plans and validate the resolution of findings to ensure sustained compliance.
• Support enterprise-wide verification studies and external audit readiness, including pre-audit documentation review and file validation.
• Collaborate with internal departments and external delegates to ensure alignment and operational consistency.

Skills

Written communication

Verbal communication

Analytical skills

Organizational skills

Time management

Independent work style

Education

Bachelor’s degree in Healthcare Administration, Public Health, Business, or related field

Tools

Microsoft Office

Audit tracking systems

Job description

About us

Community Health Plan of Imperial Valley (CHPIV) is committed to improving the health and well-being of our community by offering accessible, high-quality, and culturally sensitive healthcare services. We are a local health plan dedicated to making a positive impact through education, outreach, and innovative care.
The Compliance Auditor plays a critical role in advancing the mission of Community Health Plan of Imperial Valley (CHPIV) by ensuring that administrative/non-clinical functions performed by delegated entities are in full compliance with regulatory, contractual, and clinical standards.

About the role

Our new Compliance Auditor will do the following:

• Evaluateprocess compliance and operational workflows for internal and delegated functions.
• Identify systemic issues and contributeto corrective action planning.
• Monitorregulatory metrics and reporting to committees.
• Conduct audits of non-clinical delegated functions including claims, encounters, credentialing, language assistance services, and program effectiveness.
• Review and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and materials.
• Assess compliance with DHCS, DMHC, CMS, and NCQA regulatory requirements, as well as contractual obligations.
• Identify gaps in documentation, workflows, and performance that could result in audit findings or compliance risks.
• Monitor corrective action plans and validate the resolution of findings to ensure sustained compliance.
• Support enterprise-wide verification studies and external audit readiness, including pre-audit documentation review and file validation.
• Collaborate with internal departments and external delegates to ensure alignment and operational consistency.

About our next team member
Our new Compliance Auditor will have the following:

• Bachelor’s degree in Healthcare Administration, Public Health, Business, or a related field; equivalent experience may be considered in lieu of degree
• Minimum of 3-4 years of experience in compliance, auditing, or regulatory oversight within a managed care or healthcare delivery environment.
• Familiarity with Medi-Cal and/or Medicare regulatory requirements (DHCS, DMHC, CMS).
• Strong understanding of delegated functions such as claims, encounters, credentialing, and language assistance services.
• Demonstrated ability to review and interpret policies, procedures, and operational workflows.
• Excellent organizational, analytical, and time management skills with the ability to manage multiple priorities.
• Strong written and verbal communication skills, including the ability to draft audit findings and compliance reports.
• Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and experience working with audit tracking systems or similar tools.
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
  _ Our commitment to you _
• A competitive salary of $80,000-$100,000/ year
• Health, dental, and vision insurance that is paid 85% for you and your family
• Paid life and disability insurance
• A retirement plan with a generous match
• Paid time off
• A chance to make a real difference in the Imperial Valley community
  We are an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.