Compliance Auditor

Community Health Plan of Imperial Valley (CHPIV) is committed to improving the health and well-being of our community by offering accessible, high-quality, and culturally sensitive healthcare services. We are a local health plan dedicated to making a positive impact through education, outreach, and innovative care.

The Compliance Auditor plays a critical role in advancing the mission of Community Health Plan of Imperial Valley (CHPIV) by ensuring that administrative/non-clinical functions performed by delegated entities are in full compliance with regulatory, contractual, and clinical standards.

Our new Compliance Auditor will do the following:

• Evaluate process compliance and operational workflows for internal and delegated functions.
• Identify systemic issues and contribute to corrective action planning.
• Monitor regulatory metrics and reporting to committees.
• Conduct audits of non-clinical delegated functions including claims, encounters, credentialing, language assistance services, and program effectiveness.
• Review and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and materials.
• Assess compliance with DHCS, DMHC, CMS, and NCQA regulatory requirements, as well as contractual obligations.
• Identify gaps in documentation, workflows, and performance that could result in audit findings or compliance risks.
• Monitor corrective action plans and validate the resolution of findings to ensure sustained compliance.
• Support enterprise-wide verification studies and external audit readiness, including pre-audit documentation review and file validation.
• Collaborate with internal departments and external delegates to ensure alignment and operational consistency.

Our new Compliance Auditor will have the following:

• Bachelor’s degree in Healthcare Administration, Public Health, Business, or a related field; equivalent experience may be considered in lieu of degree
• Minimum of 3-4 years of experience in compliance, auditing, or regulatory oversight within a managed care or healthcare delivery environment.
• Familiarity with Medi-Cal and/or Medicare regulatory requirements (DHCS, DMHC, CMS).
• Strong understanding of delegated functions such as claims, encounters, credentialing, and language assistance services.
• Demonstrated ability to review and interpret policies, procedures, and operational workflows.
• Excellent organizational, analytical, and time management skills with the ability to manage multiple priorities.
• Strong written and verbal communication skills, including the ability to draft audit findings and compliance reports.
• Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and experience working with audit tracking systems or similar tools.
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.

Our commitment to you

• A competitive salary of $80,000-$100,000/ year
• Health, dental, and vision insurance that is paid 85% for you and your family
• Paid life and disability insurance
• A retirement plan with a generous match
• Paid time off
• A chance to make a real difference in the Imperial Valley community

We are an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.