Auditor

• Identifying issues and/or entities that may pose potential risk associated with fraud and abuse
• Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control
• Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations
• Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation

Clinical Provider Auditor I

• Perform retrospective quality audits (QA) of audit cases
• Validate that findings are supported, accurately documented, and consistent with audit rationale
• Ensure audit determinations appropriately apply payer policies, coding/billing guidelines, and reimbursement rules
• Confirm the audit file contains complete evidence to support recoveries/avoidance and to withstand provider appeals
• Apply established QA methodology to evaluate performance consistently
• Identify and classify errors
• Maintain quality dashboards and trending reports
• Participate in calibration sessions with reviewers
• Provide structured feedback to audit teams
• Support business reviews by summarizing quality findings, root causes, and improvement opportunities
• Recommend updates to job aids, templates, and audit checklists to reduce variation and improve defensibility
• Escalate high-risk issues to leadership

Quality Auditor, Hospital Bill Audits, Itemized Bill Review

• Audit information system applications to ensure appropriate controls
• Evaluate security controls, identify vulnerabilities, and recommend improvements
• Perform IT audit and cybersecurity-focused consulting engagements
• Collaborate with internal audit team members to align IT audit coverage with enterprise cyber risk priorities
• Develop communication skills for discussing security findings and risk acceptance decisions

Internal Auditor – Technology

• Provides systematic and strategic approaches related to the effectiveness of risk management control and governance processes
• Examines and evaluates organization processes, reporting findings back to management regarding possible improvements and corrections
• Develop internal audit scope and audit plans
• Assists in audits within the organization's internal operations as directed by leadership
• Prepare and present reports that reflect audit results and document processes
• Typically follows existing procedures to perform routine assignments and to solve standard problems
• Analyzes basic information and standard practices to make decisions impacting work performed
• Individual contributor working with direct oversight
• Performs all other duties as assigned by management

Internal Auditor I

• 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

• Review full computer system validation deliverables for regulated software, hardware, and laboratory instrumentation applications
• Conduct internal audits related to validated systems and IT processes
• Escalate unresolved observations to QA management
• Conduct vendor audits of SaaS vendors
• Prepare and distribute audit reports and assist with review of auditee response plans
• Assist QA leadership team with review of non-conformance root causes and implementation of effective corrective actions
• Maintain significant knowledge in global regulatory validation requirements
• Prepare training materials related to global validation requirements

Validation – IT Auditor II

• Review of partner documentation and records, conducting virtual and / or site audits of partner facilities and reporting on programs, procedures, and progress
• Perform appropriate risk assessments to ensure suppliers and co-manufacturers can meet quality assurance, food safety and regulatory requirements
• Complete verification audits to ensure compliance with Champion Petfoods’ food safety and quality standards
• Work with the management teams of supplier and co-manufacturer partners to evaluate programs and support development of extensive food safety and quality programs
• Provide timely and accurate reviews of supplier and with suppliers and co-manufacturers on corrective actions and closures
• Assess and mitigate any risks to Champion Petfoods when reviewing supplier and co-manufacturer food safety programs
• Assist with the development of the annual audit plan for existing supplier partners
• Work with the Ingredient Management team to coordinate the review and approvals for new supplier and co-manufacturer partners
• Support with distributor compliance verification audits, as required by the business
• Manage audit records for supplier, co and distributor partner visits, with monthly reporting on progress and deviations
• Liaise with other key departments within Champion to continuously improve Supplier Quality Assurance programs
• Support efforts of Corporate and Kitchen QA crisis management teams as required
• Perform other duties as required.

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