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Senior Internal Auditor
Jobs for Humanity. Audit and analyze claims data to ensure processing accuracy and service-level standards are met at individual, group, and enterprise levels.
About the role
Key responsibilities & impact- Audit and analyze claims data to ensure processing accuracy and service-level standards are met at individual, group, and enterprise levels.
- Review claims processing, specialty referrals, prior authorizations, benefit plans, group setup, and system configuration to confirm alignment with contracts and policies.
- Validate benefit schedules, frequency limits, and provider compensation schedules to ensure accurate system configuration and payments.
- Create and maintain claims and UM client file packets used for external audits and internal reviews.
- Support CMS ODAG and CMS Part C audits, including file preparation, tracking, and data validation activities.
- Analyze audit results, identify trends, and document findings to support training, calibration, and continuous improvement efforts.
- Collaborate with Claims, UM, Compliance, IT, and other departments to follow up on audit findings and ensure timely corrections.
- Support and test automation tools and internal bots to help meet regulatory and client requirements.
- Assist with departmental reporting, training activities, and the development or refinement of audit policies and procedures.
- Maintain professionalism and confidentiality when handling sensitive audit information.
- Perform additional duties as assigned.
Requirements
What you’ll need- Preferred Bachelor’s degree or equivalent combination of education and relevant experience
- Minimum 2 years of experience in claims processing, claims auditing, or claims data analysis (Dental PPO or DHMO environment strongly preferred)
- 1+ year of internal audit experience, preferably within a dental or healthcare setting
- Strong understanding of dental claims processing and audit methodologies
- Proficiency in Microsoft Word and Excel
- Strong analytical, reporting, and trend-analysis skills
- Excellent attention to detail and comfort working with complex data
- Ability to work independently while managing multiple priorities
- Strong written and verbal communication skills
- Discretion and professionalism when handling confidential information
- Collaborative mindset with the ability to promote teamwork across departments
Benefits
Comp & perks- Competitive pay structure and savings options to help you reach your financial goals.
- Excellent 401(k) retirement benefits, including employer match, 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. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
- 100% employer-paid dental coverage for employees and eligible dependents.
- Vision insurance with low-cost premiums for employee-only coverage and dependents.
- Company-paid basic life and AD&D insurance, equal 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.
- Expansive 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 ability to roll over unused time.
- 10 paid company holidays.
- Tuition reimbursement for eligible educational expenses.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingclaims auditingclaims data analysisaudit methodologiesdata validationreportingtrend analysisMicrosoft WordMicrosoft Excel
Soft Skills
attention to detailanalytical skillscommunication skillsdiscretionprofessionalismcollaborationability to work independentlytime management