Senior Compliance Auditor
Job Summary
To support comprehensive Medical Loss Ratio (MLR) examinations remotely, the full-time Senior Compliance Auditor will analyze documentation, perform attribute testing, and review compliance with state and federal regulations in the healthcare and insurance sectors.
Key responsibilities
- Conduct analytical reviews of documentation to ensure compliance with MLR calculations and rebate distributions
- Perform testing of premium and claims transactions for accuracy and completeness related to MLR calculations
- Review Quality Improvement Activity expenses and Pharmacy Benefit Manager contracts for regulatory compliance
Required qualifications
- Minimum 2+ years of experience in auditing or accounting within healthcare, insurance, or related fields
- Experience with MLR and related rebate requirements is required
- Bachelor's Degree in Accounting or Finance preferred
- CPA, CIA, CFE, or AFE certifications preferred but not required
- Proficiency in software tools such as TeamMate, ACL/Access/Tableau, and MS Excel
Complete Job Description
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