California Licensed Health Plans Auditor

A company is looking for a Specialty Health Plans Auditor III, Claims.

Key Responsibilities

Lead planning, execution, reporting, and corrective action monitoring for claims processing compliance across specialized health programs

Conduct annual claims audits and ensure compliance with regulatory and contractual requirements

Act as a Subject Matter Expert, mentoring staff and shaping best practices for continuous improvement

Qualifications

Bachelor's Degree in Accounting, Finance, or a related field, or equivalent education and / or experience

Minimum 5 years of experience in claims audits or claims processing related to managed care product lines

Demonstrated background in managed care, healthcare, or health insurance

Proven experience in healthcare claims audit and financial compliance

Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint)