Senior Financial Compliance Auditor – Claims

L.A. Care Health Plan; California (MO); On-site; USD 89,000 - 142,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Job summary

L.A. Care Health Plan in California seeks a Financial Compliance Auditor III Claims to audit claims processed by Delegated Participating Physician Groups and contracted health plans.

You will ensure compliance with federal and state regulations and prepare audit reports. The role requires at least 4 years of claims auditing experience, a Finance or Accounting degree, and strong data analysis and communication skills.

Qualifications

• Bachelor's Degree in Finance or Accounting or related field is required.
• In lieu of degree, equivalent education and/or experience may be considered.
• At least 4 years of claims audits or claims processing experience in Medi-Cal/Medicare or similar.

Responsibilities

• Audits claims processed by delegated groups and health plans.
• Produces timely audit reports and identifies regulatory compliance gaps.
• Mentors staff and provides subject matter expertise.
• Prepares onsite audit documentation and assists with monthly timeliness reports.

Skills

Self-motivation

Detail-oriented

Prioritization

Teamwork

Verbal and written communication

Microsoft Excel

Microsoft Word

Data analysis

Regulatory knowledge

Health insurance knowledge

Education

Bachelor's Degree in Finance or Accounting or Related Field

Master's Degree

Tools

Microsoft Excel

Microsoft Word

Job description

L.A. Care Health Plan in California seeks a Financial Compliance Auditor III Claims to audit claims processed by Delegated Participating Physician Groups and contracted health plans.

You will ensure compliance with federal and state regulations and prepare audit reports. The role requires at least 4 years of claims auditing experience, a Finance or Accounting degree, and strong data analysis and communication skills.