Delegation Operations Auditor | Compliance & Controls

Socket.dev; Long Beach (CA); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee audits of contracted delegated entities and ensure compliance with DMHC, DHCS, CMS requirements. You will review regulations and coordinate with internal teams to execute audits of provider claims, credentialing, and corrective actions.

This hybrid role supports collaboration across departments, with in-office days two per week in California.

Qualifications

• Bachelor’s degree or higher OR HS Diploma with 4 years additional relevant experience.
• 7 years of auditing delegated entities for DHCS/CMS requirements.
• Strong knowledge of CMS, DHCS, DMHC standards and related contracts.

Responsibilities

• Oversee policy and procedure reviews and conduct complex audits of delegated entities.
• Act as auditor in charge on audits of providers' claims, disputes, credentialing, and corrective action plans.
• Perform special audits of providers as requested by regulators and management.
• Research and monitor delegated entities' compliance with reporting requirements.
• Educate delegates on claims payment, credentialing, solvency, and controls.
• Provide complex analysis to improve compliance programs and internal controls.
• Collaborate on regulatory audits and findings responses.
• Assist in development of delegation policies, training, and audit tools.

Skills

Auditing delegated entities

Internal controls

Regulatory compliance

CMS/DHCS/DMHC knowledge

Data analysis

Communication

Education

Bachelor’s degree or HS Diploma + 4 years relevant experience

Job description

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee audits of contracted delegated entities and ensure compliance with DMHC, DHCS, CMS requirements. You will review regulations and coordinate with internal teams to execute audits of provider claims, credentialing, and corrective actions.

This hybrid role supports collaboration across departments, with in-office days two per week in California.