Remote Senior Utilization & Audit Compliance Analyst

Integra Partners; Connecticut; Remote; USD 77,000 - 104,000; Full time

Benefits offered by this job

Competitive compensation

Annual bonus program

401(k) retirement program with company

Life insurance

Medical, Vision, and Dental benefits

PTO

Parental Leave

Holidays and floating holidays

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits and respond to inquiries from health plans, clients, regulators, and accreditation bodies. This role involves reviewing UM data in Essette and related systems, drafting professional responses, and developing corrective action plans to improve audit readiness and compliance.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible

Qualifications

• Bachelor’s degree in healthcare administration or related field preferred.
• 5–10 years of healthcare operations, UM, and/or audit support.
• Strong written and verbal communication skills, with attention to detail.
• Experience preparing reports and analyzing data.

Responsibilities

• Serve as the primary business lead for external customer audits and oversight reviews.
• Review audit findings, inquiries, corrective action requests, and data validation requests from health plans, clients, and regulatory agencies.
• Conduct comprehensive investigations to validate audit findings and determine root causes.
• Draft clear, accurate written responses to customer audit findings.
• Develop corrective action plans and supporting documentation when appropriate.
• Track recurring issues and recommend process improvements.

Skills

Advanced Excel

Data analysis

Written communication

Regulatory knowledge

Audits coordination

Education

Bachelor’s degree in healthcare administration

Tools

Essette

UM systems

Data reporting tools

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits and respond to inquiries from health plans, clients, regulators, and accreditation bodies. This role involves reviewing UM data in Essette and related systems, drafting professional responses, and developing corrective action plans to improve audit readiness and compliance.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible