- Be responsible for overseeing policy and procedure review and completing full/complex pre-delegation, annual or follow-up onsite audits/assessments of delegated entities (including vendors) in support of the regulatory requirements
- Act as the auditor in charge on large and complex audits of provider claims, provider dispute mechanism, and other delegated non-clinical areas through to corrective action plan oversight
- Perform special audits of providers as requested by regulators, contracting, and internal management
- Research, investigate, and oversee delegated entity's compliance with reporting requirements by tracking the receipt and evaluating the completeness of reports
- Educate the delegated entities and vendors on area of expertise including but not limited to claims payment management
- Develop format and document periodic status reports from Delegated Entities
- Provide or coordinate technical assistance to delegates as needed to ensure they can comply with all requirements
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Senior IT Auditor
2 weeks ago
KabaFusion Holdings, LLC Cerritos, United States2 days ago · Requisition ID: 2544 · Salary Range: · Come join a company that is putting the "CARE" back in healthcare. · Why do IT Professionals want to work here? The reason people love working for KabaFusion is because of the impact we have on our patients. Here, it doesn't ma ...
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Senior IT Auditor
1 week ago
Buckingham Search Lake Forest, United StatesReporting to the IT Audit Manager, the Senior IT Auditor position will provide a fantastic opportunity for a candidate to learn the operations of a $16B Fortune 300 organization while setting themselves up for great promotional opportunities either within Audit, Finance or anothe ...
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Senior Auditor
1 week ago
Sterling Freeman Los Angeles, United StatesSenior Auditor – Woodland Hills, CA CPA Firm Job · Our Los Angeles area clients bring the most interesting and challenging opportunities with International, pre-IPO preparation, and ultra and high net-worth client complexities. They are leaders in industries such as technology, ...
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Senior Auditor
1 week ago
Lee Sperling Hisamune A/C Glendale, United StatesJob Description · Job Description · Company Description · Lee, Sperling, Hisamune Accountancy Corporation is a full-service firm of Certified Public Accountants and professionals located in Glendale, CA. With over 50 years of experience, we provide expert advice and services in ...
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Senior Auditor
1 week ago
East West Bank Pasadena, United StatesIntroduction: · Since 1973, East West Bank has served as a pathway to success. With over 120 locations across the U.S. and Asia, we are the premier financial bridge between the East and West. Our teams of experienced, multi-cultural professionals help guide businesses and commun ...
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Senior IT Auditor
1 week ago
Clerk of the Circuit Court of Cook County Lake Forest, United StatesThe Senior IT Auditor will conduct various IT and operational audits and support the Internal Controls over Financial Reporting (ICFR) compliance initiatives including Sarbanes-Oxley (SOX), SSAE16, HIPAA, HITRUST. · Essential Functions: · Assist in the preparation of audit plan ...
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Senior Auditor IT
1 week ago
Bienvivir All Inclusive Health Pasadena, United StatesBienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, ...
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Senior Auditor
6 days ago
We Are Legal Revolution Los Angeles, United States????NEW IN ???? ????????? Senior Audit Associate ????????????? Top 10 CPA firm | Award winning place to work for???? LA- Hybrid/Remote ???? Up to $115k · ???? Company: · Top 10 CPA firm providing full service accounting, audit, tax & advisory services · Award winning including ...
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Senior Auditor
1 week ago
Laporte CPAs and Business Advisors Los Angeles, United StatesResponsibilities Executing the day-to-day activities of audit engagements of various clients Conducting audits and other engagements using a team approach to coordinate and manage the inclusion of tax and other advisory team members on the engagement Efficiently manages fellow as ...
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Senior Auditor
2 days ago
Softcom Systems Inc Los Angeles, United StatesJob Description · Job DescriptionThis person will be responsible for managing client engagements including planning, executing, directing, and completing financial reviews and audits. · Primary Responsibilities: · Manage multiple clients while consistently meeting deadlines. · An ...
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Senior Auditor
1 week ago
East West Bank Pasadena, United StatesIntroduction: · Since 1973, East West Bank has served as a pathway to success. With over 120 locations across the U.S. and Asia, we are the premier financial bridge between the East and West. Our teams of experienced, multi-cultural professionals help guide businesses and commun ...
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Senior Auditor
1 week ago
JBA International Pasadena, United StatesAuditor Duties and Responsibilities: · Protects assets by ensuring compliance with internal control procedures and regulations. · Ensures compliance with established internal control procedures by examining records, reports, operating practices, and documentation. · Verifies a ...
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Aurora Technologies East Los Angeles, United StatesWhat to expect · As an experienced employee, you will be responsible for leading and motivating a team and acting as the main point of contact for clients on site in East Los Angeles. · You will primarily be involved in IT system audits (PS330) and project-related audits (PS850), ...
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Lead Auditor, Delegation Oversight
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Molina Healthcare Long Beach, United StatesJob Description · Job Summary · The Lead Auditor, Delegation Oversight is responsible for leading and managing the auditing of complex and multi-delegated high-risk vendors. Brings all best practices together to management for review and approval. · **Scope for this position will ...
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Senior Internal Auditor
1 week ago
Talented Search Group Costa Mesa, United StatesOur well-known, services-based client located in Costa Mesa is seeking a Senior Internal Auditor to join their internal audit function. The Senior Internal Auditor will support the organization's management to provide assurance reviews of the enterprise's control environment. The ...
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Senior Internal Auditor
2 days ago
Talented Search Group Costa Mesa, United StatesJob Description · Job DescriptionOur well-known, services-based client located in Costa Mesa is seeking a Senior Internal Auditor to join their internal audit function. The Senior Internal Auditor will support the organization's management to provide assurance reviews of the ente ...
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Senior Auditor Pasadena
1 week ago
Regal Executive Search Pasadena, United StatesJob Description · Senior Auditor · Performs and participates in planning various and diverse operational and financial audits, reviews and special projects. · Essential Responsibilities: · Contribute to the audit planning process; assist in the development of audit objectives a ...
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Senior Internal Auditor
2 weeks ago
Alliance Resource Group Costa Mesa, United StatesOur client, a well-established and long-standing company, is in search of a Sr. Internal Auditor to join their growing team In addition to solid work/life balance and stability, they also offer fantastic benefits and opportunities for career growth Internal Auditor, Auditor, Inte ...
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Senior Internal Auditor
1 week ago
Addison Group Los Angeles, United StatesJob Description · Job Description · Addison Group Los Angeles, in partnership with a management consulting firm, seeks a couple of talented accounting professionals with recent SOX and Auditing experience. · Job · –The hired · Senior Associate · will evaluate risks surround ...
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Senior Internal Auditor
1 week ago
Larson Maddox Los Angeles, United States2 days ago · Be among the first 25 applicants · Direct message the job poster from Larson Maddox · Regulatory Recruitment Consultant at Larson Maddox · A leading tech giant is looking to bring on a Senior Internal Auditor to its Los Angeles team. This company has received globa ...
Delegation Operations Auditor, Senior - Long Beach, United States - Blue Cross Blue Shield companies
Description
Your RoleThe Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC) which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities.
This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities.Reporting to the Manager, Delegation Oversight, the Delegation Operations Auditor, Senior is responsible for ensuring that delegates are compliant with all federal, state, and NCQA regulatory requirements with direct impact on the success of delegate compliance and organization oversight goals and objectives.
Your workIn this role, you will:
