Senior Health Plan Auditor
CA
Full Time
Experienced
Bright Vision Technologies is a forward-thinking software development company dedicated to building innovative solutions that help businesses automate and optimize their operations.
We leverage cutting-edge technologies to create scalable, secure, and user-friendly applications. As we continue to grow, we’re looking for a skilled Senior Health Plan Auditor to join our dynamic team and contribute to our mission of transforming business processes through technology.
This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential.
Position: Senior Health Plan Auditor
Location: Los Angeles, CA (Hybrid)
Duration: Full-Time / Permanent
Summary:
The Senior Health Plan Auditor is responsible for planning, executing, reporting, and monitoring corrective action plans related to financial solvency and claims processing compliance for specialty health plans and vendors. This role ensures compliance with regulatory requirements and contractual agreements across all lines of business.
The position also serves as a subject matter expert and mentor, supporting junior staff and contributing to process improvements and regulatory readiness.
Key Responsibilities:
REQUIREMENTS:
Education:
Experience:
Skills & Competencies:
Licenses / Certifications (Must have one):
Work Model:
Would you like to know more about this opportunity?
For immediate consideration, please send your resume directly to [email protected] or contact us at (908) 650-6382 | ext. 1009.
At BVTeck, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position offered by “No Fee Agency.”
We leverage cutting-edge technologies to create scalable, secure, and user-friendly applications. As we continue to grow, we’re looking for a skilled Senior Health Plan Auditor to join our dynamic team and contribute to our mission of transforming business processes through technology.
This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential.
Position: Senior Health Plan Auditor
Location: Los Angeles, CA (Hybrid)
Duration: Full-Time / Permanent
Summary:
The Senior Health Plan Auditor is responsible for planning, executing, reporting, and monitoring corrective action plans related to financial solvency and claims processing compliance for specialty health plans and vendors. This role ensures compliance with regulatory requirements and contractual agreements across all lines of business.
The position also serves as a subject matter expert and mentor, supporting junior staff and contributing to process improvements and regulatory readiness.
- Perform financial audits and analyses for specialty health plans and vendors
- Conduct claims processing audits to ensure regulatory and contractual compliance
- Ensure timely and accurate audit deliverables related to financial solvency
- Support quarterly and annual DMHC claims data submissions
- Serve as liaison for CMS claim audits related to L.A. Care delegates
- Monitor, track, and report corrective action plans and non-compliance notices
- Assist in developing standardized audit workpapers and reporting templates
- Maintain and annually update departmental Policies & Procedures (P&Ps)
- Support legal, delegation oversight, and regulatory requests
- Collaborate with internal departments, leadership, vendors, and plan partners
- Identify opportunities for process improvement and technical solutions
- Provide training, mentorship, and guidance to junior staff and interns
- Participate in special projects and regulatory impact assessments
Education:
- Bachelor’s Degree in Accounting or a related field (required)
- Equivalent education and/or experience may be considered in lieu of degree
- Minimum 3 years of experience conducting financial audits
- Minimum 5 years of experience in the managed healthcare industry
- At least 2 years of accounting experience
- Strong analytical and critical-thinking skills
- Excellent verbal and written communication abilities
- Ability to work independently with minimal supervision
- Strong organizational and prioritization skills
- Professional communication with internal and external stakeholders
- Proficiency in Microsoft Excel, PowerPoint, and SharePoint
- Action-oriented, self-motivated, and detail-focused
- Certified Public Accountant (CPA)
- Certified Management Accountant (CMA)
- Certified Internal Auditor (CIA)
- Certified Fraud Examiner (CFE)
- Hybrid role (#LI-Hybrid)
For immediate consideration, please send your resume directly to [email protected] or contact us at (908) 650-6382 | ext. 1009.
At BVTeck, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position offered by “No Fee Agency.”
Equal Employment Opportunity (EEO) Statement
Bright Vision Technologies (BV Teck) is committed to equal employment opportunity (EEO) for all employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, veteran status, or any other protected status as defined by applicable federal, state, or local laws. This commitment extends to all aspects of employment, including recruitment, hiring, training, compensation, promotion, transfer, leaves of absence, termination, layoffs, and recall.
BV Teck expressly prohibits any form of workplace harassment or discrimination. Any improper interference with employees' ability to perform their job duties may result in disciplinary action up to and including termination of employment.
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