Senior UM Audit & Compliance Specialist

Integra Partners; Tennessee; On-site; USD 81,000 - 99,000; Full time

Benefits offered by this job

Competitive compensation program

401(k) retirement with company match

Company-paid life insurance

Short term disability coverage

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Paid Parental Leave

Sick Time

Paid holidays and floating holidays

Quarterly company events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners seeks a Senior Utilization Management Audit & Compliance Analyst to act as the subject matter expert for external audits, regulatory inquiries, and UM oversight. You will review audit requests, analyze UM data in Essette, and prepare evidence-based responses for health plans, regulators, and clients.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong analytical and Excel skills to support audit

Qualifications

• Bachelor’s degree in healthcare administration, public health, or related field preferred.
• 5-10 years of experience in healthcare operations, UM, and/or audit support.
• Excellent written and verbal communication skills, with attention to detail and accuracy.
• Ability to build strong cross-functional relationships across Operations, IT, and external clients.

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.
• Ensure audit responses are completed accurately and within required timelines.
• Assist in customer meetings related to audit findings and performance reviews.
• Track recurring issues and recommend process improvements.
• Support implementation and monitoring of corrective action plans.
• Validate regulatory time frames, determinations, and documentation requirements.
• Research audit findings using system data and supporting records.
• Collaborate with operational teams to resolve discrepancies.
• Develop data summaries, reports, and audit exhibits.
• Identify trends, anomalies, and opportunities for operational improvement.

Skills

Advanced Excel

Analytical skills

Written communication

Verbal communication

Stakeholder collaboration

Education

Bachelor's degree in healthcare administration, public health, or related field

Tools

Essette

Pivot Tables

VLOOKUP/XLOOKUP

Job description

Integra Partners seeks a Senior Utilization Management Audit & Compliance Analyst to act as the subject matter expert for external audits, regulatory inquiries, and UM oversight. You will review audit requests, analyze UM data in Essette, and prepare evidence-based responses for health plans, regulators, and clients.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong analytical and Excel skills to support audit