This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Sr. Internal Auditor in United States.
This role is a key part of a mission-driven internal audit function focused on ensuring accuracy, compliance, and operational excellence across healthcare claims and utilization management processes. You will play an important role in reviewing claims data, validating system configurations, and supporting regulatory audit readiness activities.
Working in a highly collaborative environment, you will partner with Compliance, Claims, IT, and business teams to identify risks, analyze trends, and drive continuous improvement.
You will contribute directly to CMS audit readiness efforts and help ensure that processes align with contractual, regulatory, and internal standards.
The position requires strong analytical capability and a detail-oriented mindset to interpret complex healthcare data and audit outcomes.
You will also support automation initiatives and process enhancements that improve efficiency and accuracy across audit operations.
This is an impactful opportunity for an experienced auditor who thrives in structured, data-driven, and compliance-focused environments.
Accountabilities:- Conduct audits and analyze claims data to ensure accuracy, compliance, and adherence to service-level standards across multiple operational areas.
- Review claims processing, benefit configuration, prior authorizations, referrals, and provider payment structures for alignment with contracts and policies.
- Support CMS ODAG and CMS Part C audit activities, including file preparation, tracking, validation, and documentation.
- Develop and maintain audit file packets for claims and utilization management to support internal and external audit requirements.
- Analyze audit findings, identify trends, and contribute to training, process improvements, and quality enhancement initiatives.
- Collaborate with cross-functional teams including Claims, UM, Compliance, and IT to resolve audit findings and implement corrective actions.
- Support testing and implementation of automation tools and internal systems to improve audit efficiency and regulatory compliance.
- Assist in reporting, documentation, and refinement of audit policies and procedures while maintaining confidentiality and accuracy.
Requirements:
- 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, preferably in dental PPO or DHMO environments.
- At least 1 year of internal audit experience within healthcare or dental insurance settings preferred.
- Strong understanding of dental claims systems, audit methodologies, and healthcare benefit structures.
- Advanced analytical skills with the ability to interpret complex data sets and identify trends.
- Proficiency in Microsoft Excel and Word, with strong reporting capabilities.
- Excellent attention to detail and ability to manage multiple priorities in a deadline-driven environment.
- Strong communication skills and ability to collaborate effectively across departments.
- High level of professionalism, discretion, and integrity when handling sensitive information.
Benefits:
- Remote-first work environment with strong flexibility.
- Opportunity to contribute to healthcare quality, compliance, and member impact initiatives.
- Collaborative, mission-driven culture focused on integrity and accountability.
- Exposure to CMS audit processes and enterprise-level compliance activities.
- Career development opportunities within internal audit and healthcare operations.
- Cross-functional collaboration with Compliance, Claims, IT, and leadership teams.
- Stable role within a growing healthcare-focused organization.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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