Delegation Oversight 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 (

Life and disability insurance

Retirement plan with employer match

Paid time off

Job summary

Community Health Plan of Imperial Valley is seeking a Delegation Oversight Auditor to evaluate compliance, monitor regulatory metrics, and audit non-clinical delegated functions across the organization. You will review reports, ensure DHCS/DMHC/CMS/NCQA adherence, and collaborate with internal and external teams to mitigate risks.

The role requires a Bachelor’s degree and 3–4 years in healthcare compliance or auditing, with strong communication and MS Office skills.

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Business, or a related field.
• 3–4 years of experience in compliance, auditing, or regulatory oversight within managed care or healthcare delivery.
• 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.
• 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 with audit tracking systems or similar tools.
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.

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

Compliance

Auditing

Regulatory knowledge

Healthcare operations

Analytical thinking

Documentation

Verbal communication

MS Office

Time management

Independence

Education

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

Tools

Audit tracking systems

Microsoft Office

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 Delegation Oversight 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 Delegation Oversight 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 Delegation Oversight 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.