Senior Health Plan Auditor

Job Title

Senior Health Plan Auditor (contract to hire)

Los Angeles CA 90017

3+ month's contract to hire on W2.

1'st shift (Monday through Friday)

$(55- 57)/hr on W2. Without benefits

• Hybrid schedule with onsite presence required once per month.

The Senior Health Plan Auditor is responsible for planning, executing, and reporting on financial and claims audits to ensure compliance with regulatory requirements and contractual obligations across all lines of business. This role supports financial solvency operations, state compliance filings (including AB1455), and DMHC claims data submissions for L.A. Care and its Plan Partners. The auditor will also develop corrective action plans (CAPs), mentor junior staff, and serve as a subject matter expert in managed care auditing practices.

• Financial Audits & Analysis:
  Conduct audits and financial analyses for specialty health plans, vendors, and capitated hospitals.
• Claims Audits:
  Perform claims audits to ensure compliance with DMHC and CMS requirements.
• Risk Assessment:
  Analyze financial statements, recognize industry trends, identify issues, and recommend corrective actions.
• CAPS Implementation:
  Develop and monitor corrective action plans with providers as needed.
• Cost Analysis:
  Perform root cause and cost analyses to identify inefficiencies and risks.
• Compliance Oversight:
  Support quarterly and annual DMHC filing submissions and ensure adherence to AB1455 and other state regulations.
• Policy Development:
  Create, review, and update departmental policies and procedures annually.
• Collaboration:
  
  Act as liaison with CMS, legal, and interdepartmental teams; communicate effectively with plan partners and providers.
• Mentorship:
  Provide training, mentorship, and process improvement recommendations to junior staff and interns.
• Special Projects:
  Support design, implementation, and reporting of special projects and compliance monitoring tools.

• Bachelor's Degree in Accounting or related field (or equivalent education/experience).

• Minimum 3 years conducting financial audits.
• At least 5 years of experience in managed health care, insurance, or related industry.
• Minimum 2 years of accounting experience.
• Medicaid/Medicare auditing experience strongly preferred.

• Strong analytical and critical thinking abilities.
• Excellent verbal and written communication skills.
• Ability to work independently and prioritize assignments.
• Proficiency in Microsoft Office (Excel, PowerPoint, SharePoint).
• Action-oriented, self-starter, and effective motivator.

• CPA - Certified Public Accountant
• CMA - Certified Management Accountant
• CIA - Certified Internal Auditor
• CFE - Certified Fraud Examiner
• CISA - Certified Information Systems Auditor