Healthcare Compliance & Quality Auditor

Evolving Solution Services; Orange (CA); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

403(b) with company match

Paid time off

Job summary

WeShare in Orange, CA is seeking an Operations & Compliance Auditor to ensure accuracy, compliance, and efficiency across call-center and operational workflows. The role conducts advanced audits across multiple channels, identifies gaps, and provides strategic insights protecting revenue and member experience.

Operating with minimal supervision, the auditor serves as a subject matter expert and escalation resource for leadership on quality, compliance, and process improvement initiatives.

Qualifications

• HS Diploma/GED or higher.
• 1+ year in QA, auditing, compliance review, call-center QA, or customer service.
• Experience auditing calls, written correspondence, and case documentation.
• Strong analytical skills with trend and root-cause identification.
• High attention to detail and confidentiality; ability to work with minimal supervision.
• Excellent written and verbal communication skills; reliable and objective.

Responsibilities

• Conduct risk-based audits across calls, case documentation, emails, texts, escalations, and retention/saves.
• Perform high-risk and escalated audits requiring independent judgment and regulatory awareness.
• Identify systemic process gaps, compliance deviations, terminology inconsistencies, operational risks, and provide actionable recommendations.
• Perform peer-to-peer audits and audit the auditors.
• Serve as a subject matter expert for eligibility, application outcomes, cancellations, reinstatements, saves, and compliance workflows.
• Act as an escalation resource for complex or high-risk cases.
• Ensure adherence to internal protocols, documentation standards, and compliance requirements.
• Proactively identify and resolve operational or compliance issues with a solutions-oriented approach.
• Analyze audit trends and performance metrics to support leadership decision-making.
• Provide complete, accurate reporting with clear recommendations.

Skills

QA experience

Analytical skills

Attention to detail

Written & verbal communication

Independent judgment

Organizational skills

Bilingual (Spanish/English)

Education

HS Diploma/GED or higher

Tools

Excel

Job description

WeShare in Orange, CA is seeking an Operations & Compliance Auditor to ensure accuracy, compliance, and efficiency across call-center and operational workflows. The role conducts advanced audits across multiple channels, identifies gaps, and provides strategic insights protecting revenue and member experience.

Operating with minimal supervision, the auditor serves as a subject matter expert and escalation resource for leadership on quality, compliance, and process improvement initiatives.