Auditor

• Execute portions of the Risk & Control Services plan, including audit activities and SOX/MAR/FDICIA compliance activities.
• Present objectives and results to various levels of management.
• Execute on a structured approach to evaluate and improve the effectiveness of risk management, control and governance processes.
• Identify control deficiencies, assess exposure and significance, and propose cost effective recommendations.
• Monitor and validate Management Action Plan status and recommend closure of Management Action Plans when actions are complete and identified deficiencies have been addressed.
• Coordinate with appropriate control groups in planning and executing assigned work.
• Complete work within established timelines.
• Proactively communicate/escalate challenges and roadblocks that impact ability to meet established timelines.
• Gather information and provide input into risk assessments in conformance with department standards.

IT Staff Auditor

• Conducts NCQA/URAC related UM and CM file reviews to ensure survey readiness
• Designs and implements quality improvement activities if goals are not met
• Analyzes data and prepares quality management reports in accordance with BH QM principles
• Participates in intra-departmental teams to improve sustainable member outcomes
• Assists in defining opportunities for improvement identified through analysis of trends
• Assists with coordinating improvement activities

Behavioral Health Clinical Auditor

• Assisting in identifying preliminary audit scoping, including performing technical research, conducting stakeholder interviews, and preparing audit questionnaires
• Performing walkthroughs, document risk, and controls documentation
• Executing specific audit procedures and preparing work, documenting the procedures performed
• Evaluating the adequacy and effectiveness of internal controls to identify key controls, weaknesses, and compensating controls, identifying areas for improved control, cost savings, and operational efficiency
• Drafting audit recommendations for inclusion in audit reports and memos for review by Audit Manager utilizing scoping documentation completed during planning phase and testing results completed during fieldwork phase
• Performing follow-up work on past audit recommendations as directed by audit management to determine adequacy of corrective actions taken by management; to be completed within SLA
• Completing work timely and accurately to ensure project milestones are achieved, implementing effective problem-solving skills to meet project objectives
• Applying judgment to ensure professional standards are satisfied, with guidance from colleagues
• Identifying matters and issues that should be reviewed and/or escalated to higher levels of management
• Completing special studies and projects as may be assigned

Staff Internal Auditor

• The Pharmacy Network Auditor is responsible for the maintenance and growth of the Pharmacy Network Audit program and processes at RxSense
• Evaluates, reports and monitors all aspects pertaining to Pharmacy Network Auditing services
• Serves as a subject matter expert regarding standard monitoring measures, auditing procedures, and best practices
• Assesses risks suggested by audit vendor, performs appropriate audit procedures, and collaborates with pharmacy management for efficient issue resolution
• Drafts and communicates audit findings to internal stakeholders; provides Quarterly Network Audit Performance Reports to leadership
• Screens and summarizes authorized vendor audit results
• Reviews results to identify fraudulent, erroneous, or abusive billing activity
• Analyzes claims data for potential investigational FWA breaches of network pharmacies
• Maintains audit documentation, and prepares statistical data for review and action
• Develops and updates Standard Operating Procedures for audit and FWA Programs
• Collaborates with key stakeholders to support pharmacy network initiatives.

Pharmacy Network Auditor

• Partner with business teams to understand end-to-end processes and challenge existing ways of working
• Lead audit engagements with a hands-on, critical thinking mindset
• Prepare clear, compelling audit documentation and reporting
• Partner with and advise business stakeholders on internal controls, risk management, and process redesign initiatives
• Champion a continuous improvement mindset across the audit function and business stakeholders
• Support SOC 1 compliance while helping evolve controls as processes change
• Drive continuous improvement within the Internal Audit function
• Act as a trusted advisor to stakeholders on risk, controls, and process transformation initiatives
• Act as a technical resource for audit methodology and process analysis
• Assist external auditors and other third parties as required

Lead Internal Auditor

• Determining proper premium for risks by auditing policyholder’s records
• Verifying operations, classifications, and allocations of exposures
• Identifying additional exposures ensuring proper premium calculations
• Communicate findings to insureds, underwriters, brokers, and unit stat filings to NCCI and State Bureaus
• Report changing financial conditions and operations to Underwriting
• Review claims to verify employment and proper classifications

Auditor jobs in Massachusetts

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IT Staff Auditor

Behavioral Health Clinical Auditor

Staff Internal Auditor

Pharmacy Network Auditor

Lead Internal Auditor

Senior Field Auditor Specialist