Compliance Auditor II

IEHP

Rancho Cucamonga (CA)

On-site

USD 80,059 - 106,059

Full time

14 days+

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Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, vision

Life and disability insurance

Career development

Wellness programs

FSA health/childcare

CalPERS retirement

457(b) match

Pet care insurance

Job summary

IEHP is seeking a Compliance Auditor II to conduct comprehensive audits across the Plan, ensuring adherence to Federal, State, and contract requirements. You will identify risks, draft findings, and develop corrective action plans, overseeing reviews of operations, policies, and processes.

The role requires strong knowledge of California managed care regulations, excellent written and verbal communication, and the ability to operate with minimal supervision. Hybrid work options available.

Qualifications

Minimum five (5) years in managed care operations.
Professional audit experience.
Experience with California managed care regulations.
Two (2) years of audit or quality assurance/quality improvement experience.
Bachelor’s degree required; four years of additional relevant work experience may substitute.
Certifications preferred: CIA, CHC, CHA, CHIAP.

Responsibilities

Conduct comprehensive audits across the Plan and delegates to ensure compliance with regulatory requirements.
Identify and assess risks; draft audit findings and actionable recommendations.
Evaluate operations, policies, and processes for compliance and effectiveness.
Issue corrective action plans and monitor acceptance and remediation.
Participate in special reviews as necessary.

Skills

Audit standards

Risk assessment

Regulatory compliance

Data interpretation

Written communication

Problem solving

Microsoft Office

Education

Bachelor’s degree

Alternative experience for degree

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Job description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Role Overview

The Compliance Auditor II conducts comprehensive audits and reviews across the Plan, including assigned areas and Plan delegates, to ensure adherence to Federal, State, and contractual regulatory requirements. Identifies and assesses risks impacting overall compliance, drafts detailed audit findings and actionable recommendations, and evaluates operations, policies, and processes throughout the Plan. Conducts evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues. Issues corrective action plans and reviews for acceptance to ensure that all compliance issues are appropriately addressed. Performs validation audits to determine if actions have been taken to mitigate identified risks and conducts routine monitoring across the Plan to address compliance concerns and emerging risks. Participates in special reviews as necessary.

Commitment to Quality

The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Education & Requirements

Minimum of five (5) or more years in managed care operations required, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, Delegation Oversight, Quality Management, Care Management, and/or Grievances and Appeals.
Demonstrated experience, at a professional level, in an audit role.
Experience with interpretation and/or implementation of California managed care regulations.
Two (2) years of audit or quality assurance/quality improvement experience required.
Bachelor’s degree from an accredited institution required. In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position, this experience is in addition to the minimum years listed in the Experience Requirements above.
Certified Internal Auditor (CIA), Certified Health Care Compliance (CHC), Certified Healthcare Auditor (CHA), and/or CHIAP (Certified Healthcare Internal Audit Professional) preferred.

Key Qualifications

Demonstrated understanding of audit standards and requirements, statistical data interpretation and applicability, risk assessment and control environments, audit theory and processes, and of the professional practice standards of internal auditing.
Demonstrated current knowledge of business ethics and compliance risks and the knowledge to assist with management of those risks in a dynamic health care environment.
Proficient knowledge of CMS Program Audit Protocols, DHCS Technical Assistance Guides, and DMHC Technical Assistance Guides.
Knowledge of regulatory research and regulations that apply to California Managed Care Health Plans.
Possess strong written and verbal communication skills, including a strong business writing aptitude.
Possess strong problem solving and creative thinking skills and the ability to reprioritize workload as needed.
Must be detail oriented, self-directed, and work with minimal supervision, both independently and in teams.
Requires well-developed skills in problem identification, analysis, resolution, organization, prioritization, timeliness, and attention to detail.
Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook, etc.). Advanced skills in MS Excel preferred.
Effective in a consulting role with the ability to become a trusted advisor.
Ability to maintain excellent interpersonal relationships within the department and at all levels of the organization.
Ability to organize thoughts and data into well‑organized communications and reports.