Auditor

• Conducts audits of the financial, management, and administrative procedures of assigned divisions, providers, departments, and various lines of businesses throughout the organization to ensure that procedures are in compliance.
• Audits include interviewing key personnel, conducting testing, evaluating internal controls, analyzing existing financial and management practices to determine effectiveness, and reviewing relevant documentation to support findings.
• Develops detailed reports on each audit conducted.
• Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes.
• Conducts testing of corrective actions as identified.
• Conducts special audit studies for management, such as those required to discover controls for prevention of fraud.
• Prepares reports of finding and recommendations for management.
• Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel.

Auditor I, Medicare

• Independently and objectively helps plan and execute audits in accordance with professional auditing standards
• Performs or supports audits focused primarily on operational controls, asset safeguarding, and compliance with procedures, laws, and regulations
• Functions as in-charge auditor of the most complex audit reviews and/or cost reports
• May conduct reviews of account reconciliations performed by various financial areas
• Identifies and analyzes related key processes, systems, and controls to determine effectiveness
• Communicates audit status and results to management, with emphasis on discussing deficiencies and recommending corrective actions
• Prepares formal written work papers and reports, documenting audit work performed and expressing conclusion
• Assesses desk reviews performed by subordinate auditors to ensure that quality audit work is performed and on-the-job training is provided as necessary
• Assists in ensuring that all assigned audits are completed and reviewed in accordance with Generally Accepted Accounting Principles, Generally Accepted Auditing Standards and, Government Auditing Standards
• Coordinates the completion of these assignments in a manner which results in timely completion of all assignments in accordance with budget performance requirements as well as departmental interim goals
• Directs the day-to-day efforts of assigned audit staff by reviewing and planning assignments, training, and providing leadership and guidance
• Assists in the development and revision of work instructions, forms, and procedures
• Broadens and maintains working knowledge of applicable laws, regulations, and procedures through self-study programs, on-the-job training, attending seminars and network association’s formal training programs
• Communicates with internal and external areas as necessary to ensure efficient completion of assigned tasks

Lead Auditor, Medicare

• Leads and performs complex internal audits and coordinates related large-scale projects.
• Identifies, documents, and analyzes audit findings and develops audit programs that address and test identified key risks.
• Performs follow-up audits and monitoring to ensure appropriate adherence to policies and procedures.
• Monitors compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation.
• Evaluates opportunities for improvement, develops recommendations, and presents improvement opportunities/audit findings to leadership.
• Acts as a resource to educate, consult and collaborate with staff on various audit related topics.
• Guides and educates departments on methods to decrease risk and increase compliance in organizational-wide programs, policies, and procedures.
• Assists the independent external auditors by gathering information, answering questions, executing testing, coordinating any further assistance needed, and performing related projects.
• Assists with establishment of annual audit plans by leading discussions with management to identify timing, scope and objectives of audits.
• Assists with the coordination of risk models/assessments to identify and develop an audit plan to address potential risks for specific audit scope areas.
• Ensures alignment of audit and project plans with risk assessment.

Senior Internal Auditor – Compliance

• Perform internal QMS audits in accordance with applicable QMS standard(s) and internal requirements
• Develop and manage audit plans and schedules
• Conduct risk analysis to determine audit focus areas
• Support and advise site management on preparation for third party audits
• Perform benchmarking of enterprise best-practices
• Review complex proposals, contracts, regulatory, program and customer requirements for effective implementation in QMS
• Advise leadership on development of business strategies influencing directives and policies
• Consult in high level reviews of corrective actions at site, enterprise and customer level to assure trends and systemic issues are identified
• Conduct research, compile and analyze performance reports and process control statistics for continuous improvement
• Represent Company on industry working groups to develop industry standards for quality as needed

Senior Internal Quality Auditor, Level 3/4

• Conduct complex and high-level audits.
• Collaborate effectively with internal and external colleagues at all levels.
• Ensure compliance with industry regulations and company standards.
• Independently perform comprehensive audits across different areas of property and casualty insurance, including claims, underwriting, and compliance.
• Develop individualized audit plans tailored to meet the specific objectives and preferences of each client.
• Prepare and present audit findings and recommendations to senior management.
• Collaborate with various departments to implement audit recommendations.
• Support company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together.
• Perform other duties as assigned.

Senior Property and Casualty Auditor

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Auditor I, Medicare

Lead Auditor, Medicare

Senior Internal Auditor – Compliance

Senior Internal Quality Auditor, Level 3/4

Senior Property and Casualty Auditor

Coding Data Quality Auditor, Analyst