Compliance Auditor II

IEHP

Compliance Auditor II at IEHP conducting audits to ensure adherence to regulatory requirements. Evaluating compliance and validating actions for improvement in managed care operations.

Posted 7/16/2026full-timeRancho Cucamonga • California • 🇺🇸 United StatesMid-LevelSenior💰 $80,059 - $106,059 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting audits and compliance assessments within managed care operations, with a strong focus on regulatory adherence and risk management. Proficient in developing corrective action plans and evaluating operational effectiveness to ensure compliance with California managed care regulations.

Highest-signal resume keywords

Audit ExperienceRegulatory ComplianceRisk AssessmentCorrective Action PlansManaged Care Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Audit ProceduresTesting ActivitiesDocumenting FindingsValidation AuditsCompliance AssessmentsOperational EvaluationsRegulatory ResearchRisk MitigationQuality AssuranceQuality Improvement

Soft Skills

CommunicationProblem-SolvingAnalytical ThinkingCollaborationAttention to Detail

Certifications & Qualifications

Certified Internal Auditor (CIA)Certified Health Care Compliance (CHC)Certified Healthcare Auditor (CHA)Certified Healthcare Internal Audit Professional (CHIAP)

Industry Keywords

Managed CareUtilization ManagementClaimsPharmacy OperationsComplianceDelegation OversightQuality ManagementCare ManagementGrievances and AppealsCalifornia Managed Care Regulations

About the role

Key responsibilities & impact

Conduct audits and testing procedures of assigned areas and Plan delegates, including detailed testing activities, documenting findings in audit work papers, developing detailed document requests lists, conducting walk-throughs, and proposing recommendations for improvement.
Develop and maintain audit tools based on regulatory compliance with DHCS, DMHC, and CMS requirements.
Document audit conclusions that are based on a complete understanding of the process, circumstances, and risk.
Perform validation audits to determine if actions have been taken to mitigate risks identified.
Support the development and acceptance of corrective action plans (CAPs) from internal departments and delegates to ensure accuracy and regulatory adherence.
Validate corrective action plans (CAPs) from internal departments and delegates to ensure appropriate completion and make necessary recommendations as needed for compliance.
Perform evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues.
Support the identification of and communicates issues raised, offering recommended solutions relevant to business and risk.
Conduct regulatory research and provides interpretation of regulations to ensure appropriate application.
Support the maintenance of risks for assigned areas in the Compliance Risk Universe to ensure risk mitigations plans are developed and risks assessed and refreshed as needed.
Support the development of risk assessments to identify compliance risks posed to the Plan.
Conduct routine monitoring activities to ensure compliance with regulatory and contractual requirements.
Assist with reports for presentation to the Executive Compliance Committee and the IEHP Governing Board.
Conduct compliance assessments as needed.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Requirements

What you’ll need

Minimum or five (5) or more years in managed care operations required, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, Delegation Oversight, Quality Management, Care Management, and/or Grievances and Appeals
Demonstrated experience, at a professional level, in an audit role
Experience with interpretation and/or implementation of California managed care regulations
Two (2) years of audit or quality assurance/quality improvement experience required
Bachelor’s degree from an accredited institution required
In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
This experience is in addition to the minimum years listed in the Experience Requirements above
Certified Internal Auditor (CIA), Certified Health Care Compliance (CHC), Certified Healthcare Auditor (CHA), and/or CHIAP (Certified Healthcare Internal Audit Professional) preferred

Benefits

Comp & perks

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement 457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance