Impactful Compliance Auditor - Managed Care Standards

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

Benefits offered by this job

Health, dental, and vision insurance (

Job summary

Community Health Plan of Imperial Valley is seeking a Compliance Auditor to ensure non-clinical delegated functions comply with regulatory, contractual, and clinical standards. You will evaluate workflows, identify issues, monitor metrics, and conduct audits across claims, credentialing, and language services, while collaborating with internal teams to maintain ongoing compliance.

The role requires a Bachelor's degree in a related field and 3–4 years in compliance or auditing, with familiarity

Qualifications

• Bachelor’s degree in Healthcare Administration, Public Health, Business, or related field.
• Minimum 3–4 years of compliance, auditing, or regulatory oversight experience.
• Familiarity with Medi-Cal and/or Medicare (DHCS, DMHC, CMS) requirements.
• Strong understanding of delegated functions such as claims, encounters, credentialing, language services.

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 (claims, encounters, credentialing, language services).
• Review and validate accuracy and timeliness of delegate-submitted reports and logs.
• Assess compliance with regulatory and contractual obligations; identify documentation gaps.
• Monitor corrective action plans and validate resolution of findings.
• Support verification studies and pre-audit documentation review.
• Collaborate with internal departments and delegates to ensure alignment.

Skills

Analytical

Organizational skills

Time management

Education

Bachelor’s degree in Healthcare Administration or related field

Tools

Microsoft Office

Audit tracking systems

Job description

Community Health Plan of Imperial Valley is seeking a Compliance Auditor to ensure non-clinical delegated functions comply with regulatory, contractual, and clinical standards. You will evaluate workflows, identify issues, monitor metrics, and conduct audits across claims, credentialing, and language services, while collaborating with internal teams to maintain ongoing compliance.

The role requires a Bachelor's degree in a related field and 3–4 years in compliance or auditing, with familiarity