Sr. Internal Auditor

As a Sr. Internal Auditor, you will support day‑to‑day audit activities across claims, utilization management, and system configuration while playing an important role in regulatory compliance and quality improvement initiatives.

• 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.