Senior Health Plan Auditor

Solugenix; Los Angeles (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading health insurance firm is seeking a Senior Health Plan Auditor for a 4+ month contract based in Los Angeles, CA. The role involves conducting financial audits and analyses for Specialty Health Plans, ensuring compliance with regulatory requirements, and providing mentorship to junior staff. Candidates should have a Bachelor’s degree in Accounting and relevant experience in financial audits and managed healthcare.

Qualifications

• At least 3 years of experience in conducting financial audits.
• Minimum of 2 years of accounting experience.
• At least 5 years of related experience in the managed healthcare industry.

Responsibilities

• Perform financial audits and analyses for Specialty Health Plans.
• Serve as primary contact for the CMS claim audit section.
• Provide training and mentoring to junior staff.

Skills

Strong analytical and critical thinking skills

Excellent verbal and written communication skills

Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint)

Action‑oriented and self‑starter

Ability to interface professionally with customers

Education

Bachelor's Degree in Accounting or Related Field

Tools

Microsoft Office

Job description

Base pay range

$55.00/hr - $57.00/hr

Contract

4+ Month Contract (Possibility of Conversion)

Job ID

25-09680

Overview

Solugenix is assisting a client, a health insurance company, in their search for a Senior Health Plan Auditor. This 4+ month contract opportunity is based out of Los Angeles, CA (Remote).

Responsibilities

• Performs financial audits and/or financial analyses for Specialty Health Plans.
• Performs financial analyses or vendor management for the client vendors.
• Performance claims audits for Specialty Health Plans and vendors.
• Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors.
• Assists in the creation and implementation of standardized Specialty Health Plans and vendors workpaper and reporting templates.
• Responsible for the documentation and maintenance of the Financial Compliance Department's policies and procedures.
• Responsible for collection and completion of the quarterly and annual Department of Managed Health Care (DMHC) filing submissions.
• Being cross trained on financial solvency reviews for PPGs, PPs, and capitated hospitals.
• Serves as primary contact and liaison for the Centers for Medicare and Medicaid Services (CMS) claim audit section of the client delegates.
• Annually reviews and updates the department's Policies and Procedures (P&Ps). Ensures that any new or updated Policy and Procedure is reviewed and approved by management prior to submission.
• Accountable for the completion of requests from the Legal Department, Delegation Oversight's monitoring oversight and reporting.
• Serves as subject matter expert in assigned areas and cross-training initiatives.
• Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, specialty health plans, and vendors.
• Supports the design, implementation, and reporting of special projects.
• Supports the design and implementation of reports and tools for corrective action plan issuance and non‑compliance notifications.
• Supports the assessment, communication, and implementation of regulatory requirements that may impact internal processes.
• Supports the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development.
• Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge.
• Provides training, recommend process improvements, and mentor junior‑level staff, department interns, etc. as needed.
• Performs other duties as assigned.

Qualifications

• Education: Bachelor's Degree in Accounting or Related Field. In lieu of a degree, equivalent education and/or experience may be considered.
• Experience: At least 3 years of experience in conducting financial audits.
• Experience: At least 5 years of related experience in the managed healthcare industry.
• Experience: Minimum of 2 years of accounting experience.

Skills

• Strong analytical and critical thinking skills.
• Action‑oriented, self‑starter, and an excellent motivator.
• Excellent verbal and written communication skills.
• Able to prioritize assignments, and able to independently with minimum supervision.
• Ability to interface professionally with both internal and external customers at all levels of the organization.
• Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).
• Must have Managed care, health care, insurance background financial audit/analyst experience.
• Must have any of the following certifications: CMA OR CIA OR CPA OR CFE OR CISA.
• Supporting the Financial audit/Claims Audit, Financial Solvency operations. Support State Compliance Filing, AB1455.

Licenses/Certifications (Must hold one of the below certifications):

• Certified Public Accountant (CPA)
• Certified Internal Auditor (CIA)

Pay Range for CA, CO, IL, NJ, NY, WA, and DC:

$55.00/hr to $57.00/hr

Client

Our client is one of the world's leading health insurance companies based out of Los Angeles, CA.