Senior Internal Auditor

This is a fully remote position, open to applicants in California.

📋 Description

• Conduct audits and analyze claims data to guarantee processing accuracy and adherence to service-level standards at the individual, group, and enterprise levels.

• Examine claims processing, specialty referrals, prior authorizations, benefit plans, group setup, and system configuration to ensure alignment with contracts and policies.

• Verify benefit schedules, frequency limits, and provider compensation schedules to confirm precise system configuration and payments.

• Develop and maintain claims and UM client file packets utilized for external audits and internal evaluations.

• Assist with CMS ODAG and CMS Part C audits, encompassing file preparation, tracking, and data validation tasks.

• Evaluate audit results, identify patterns, and document findings to facilitate training, calibration, and continuous improvement initiatives.

• Collaborate with Claims, UM, Compliance, IT, and other departments to address audit findings and ensure prompt corrections.

• Support and test automation tools and internal bots to satisfy regulatory and client obligations.

• Aid with departmental reporting, training initiatives, and the development or enhancement of audit policies and procedures.

• Uphold professionalism and confidentiality while managing sensitive audit information.

• Perform additional tasks as assigned.

⛳️ Requirements

• Preferred Bachelor’s degree or a comparable combination of education and relevant experience.

• At least 2 years of experience in claims processing, claims auditing, or claims data analysis (experience in Dental PPO or DHMO environments is strongly preferred).

• Minimum of 1 year of internal audit experience, ideally within a dental or healthcare context.

• Strong comprehension of dental claims processing and audit methodologies.

• Proficient in Microsoft Word and Excel.

• Exceptional analytical, reporting, and trend-analysis capabilities.

• Keen attention to detail and comfort working with intricate data.

• Ability to work independently while juggling multiple priorities.

• Strong written and verbal communication abilities.

• Discretion and professionalism when managing confidential information.

• Collaborative attitude with the capacity to foster teamwork across departments.

🏝️ Benefits

• Competitive pay structure and savings options to help you achieve your financial objectives.

• Excellent 401(k) retirement benefits, including employer matching, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.

• Affordable medical insurance with low-cost premiums for employee-only coverage, with Liberty subsidizing costs for eligible dependents enrolled in the plan.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance with inexpensive premiums for employee-only coverage and dependents.

• Company-paid basic life and AD&D insurance, equivalent to one times your base salary, with options to purchase additional supplemental coverage.

• Flexible Spending Accounts for healthcare and dependent care expenses.

• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.

• Long-term disability coverage.

• Comprehensive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.

• Employee Assistance Program (EAP) to support mental health and well-being.

• Generous vacation and sick leave policies with the option to roll over unused time.

• 10 paid company holidays.

• Tuition reimbursement for eligible educational expenses.