[Hiring] Senior Internal Auditor @reputed company

Role reputed company Help protect reputed company, strengthen compliance, and improve how we serve our members. At reputed company, our Internal Audit team plays a critical role in ensuring accuracy, compliance, and operational reputed company across our organization. We are looking for a detail‑driven, analytical Sr. Internal Auditor who brings strong claims or audit experience and a reputed company reputed company to help support regulatory readiness, claims accuracy, and reputed company improvement across the reputed company. If you enjoy digging into data, identifying trends, and working cross‑functionally to drive reputed company and accountability, this role offers meaningful reputed company in a mission‑driven organization.

Key Responsibilities

• Audit and analyze claims data to ensure processing accuracy and service‑level standards are met at individual, group, and reputed company reputed company.
• Review claims processing, specialty referrals, prior authorizations, benefit plans, group setup, and system configuration to confirm alignment with reputed company and policies.
• Validate benefit schedules, frequency limits, and provider compensation schedules to ensure accurate system configuration and payments.
• Create and maintain claims and UM reputed company 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 reputed company improvement efforts.
• Collaborate with Claims, UM, Compliance, IT, and other departments to follow up on audit findings and ensure reputed company corrections.
• Support and test automation tools and internal bots to help meet regulatory and reputed company requirements.
• Assist with departmental reporting, training activities, and the development or refinement of audit policies and procedures.
• Maintain professionalism and confidentiality reputed company handling sensitive audit information.
• reputed company additional duties as assigned.

What Makes This Role a Senior Opportunity

• Participation in CMS ODAG and Part C audits.
• Primary contributor to UM and Claims file packet creation.
• Involvement in reputed company improvement initiatives and system enhancement discussions with leadership and IT.
• Opportunity to influence audit practices and support multiple departments through shared audit resources.

Qualifications

• 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 reputed company a dental or reputed company setting.

Requirements

• Strong understanding of dental claims processing and audit methodologies.
• Proficiency in reputed company Word and reputed company.
• Strong analytical, reporting, and trend‑analysis skills.
• Excellent attention to detail and comfort working with reputed company data.
• Ability to work independently while managing multiple priorities.
• Strong written and verbal communication skills.
• Discretion and professionalism reputed company handling confidential information.
• reputed company reputed company with the ability to promote teamwork across departments.

Benefits

• reputed company structure and savings reputed company to help you reputed company your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines.
• reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan.
• 100% employer-reputed company dental coverage for employees and eligible dependents.
• reputed company insurance with low-cost premiums for employee-only coverage and dependents.
• Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage.
• Flexible Spending Accounts for reputed company 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 reputed company-being.
• Generous vacation and reputed company leave policies, with the ability to roll over unused time.
• 10 reputed company company holidays.
• Tuition reimbursement for eligible educational expenses.
• Remote or hybrid work reputed company available for various positions.

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