Financial Compliance Auditor: Claims

Insight Global is looking for a Sr. Financial Compliance Auditor for one of the largest health systems in the country. This person will be responsible for for conducting audits of claims processed by medical groups and health plans contracted with L.A. Care, focusing on regulatory and contractual compliance across Medi-Cal, Medicare, Covered California, and PASC-SEIU programs. Serves as a subject matter expert and mentor, supporting audit planning, execution, and reporting.

Key Responsibilities:
Perform claim audits independently, ensuring compliance with timeliness and appropriateness standards.
Prepare audit reports and communicate findings promptly (within one week of audit).
Analyze financial and operational data from plan partners and delegated entities.
Set up and maintain audit work papers; complete related administrative tasks.
Assist with monthly and quarterly reporting (e.g., MTR, OMT).
Conduct oversight of delegates and subcontracted claims processors.

We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form. The EEOC "Know Your Rights" Poster is available here.

To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .

Qualifications:
Education: Bachelors degree required; Masters preferred. Equivalent experience may be considered.
Experience: Minimum 5 years in claims audits or processing within managed care (e.g., Medi-Cal, Cal MediConnect).
Skills:
Strong analytical, communication, and organizational skills
Ability to work independently and collaboratively
In-depth knowledge of healthcare regulations and claims processing systems
Reliable transportation for off-site audits

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.