Compliance Auditor
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Overview
Schedule
Full-time
Career level
Senior-level
Remote
On-site
Compensation
$80,000-$100,000/year
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Job Description
About usCommunity Health Plan of Imperial Valley (CHPIV) is committed to improving the health and well-being of our community by offering accessible, high-quality, and culturally sensitive healthcare services. We are a local health plan dedicated to making a positive impact through education, outreach, and innovative care.
The Compliance Auditor plays a critical role in advancing the mission of Community Health Plan of Imperial Valley (CHPIV) by ensuring that administrative/non-clinical functions performed by delegated entities are in full compliance with regulatory, contractual, and clinical standards.About the role
Our new Compliance Auditor will do the following:- Evaluate process compliance and operational workflows for internal and delegated functions.
- Identify systemic issues and contribute to corrective action planning.
- Monitor regulatory metrics and reporting to committees.
- Conduct audits of non-clinical delegated functions including claims, encounters, credentialing, language assistance services, and program effectiveness.
- Review and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and materials.
- Assess compliance with DHCS, DMHC, CMS, and NCQA regulatory requirements, as well as contractual obligations.
- Identify gaps in documentation, workflows, and performance that could result in audit findings or compliance risks.
- Monitor corrective action plans and validate the resolution of findings to ensure sustained compliance.
- Support enterprise-wide verification studies and external audit readiness, including pre-audit documentation review and file validation.
- Collaborate with internal departments and external delegates to ensure alignment and operational consistency.
About our next team member
Our new Compliance Auditor will have the following:- Bachelor’s degree in Healthcare Administration, Public Health, Business, or a related field; equivalent experience may be considered in lieu of degree
- Minimum of 3-4 years of experience in compliance, auditing, or regulatory oversight within a managed care or healthcare delivery environment.
- Familiarity with Medi-Cal and/or Medicare regulatory requirements (DHCS, DMHC, CMS).
- Strong understanding of delegated functions such as claims, encounters, credentialing, and language assistance services.
- Demonstrated ability to review and interpret policies, procedures, and operational workflows.
- Excellent organizational, analytical, and time management skills with the ability to manage multiple priorities.
- Strong written and verbal communication skills, including the ability to draft audit findings and compliance reports.
- Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and experience working with audit tracking systems or similar tools.
- Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
- A competitive salary of $80,000-$100,000/ year
- Health, dental, and vision insurance that is paid 85% for you and your family
- Paid life and disability insurance
- A retirement plan with a generous match
- Paid time off
- A chance to make a real difference in the Imperial Valley community
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FAQs About Compliance Auditor Jobs at Community Health Plan of Imperial Valley
What is the work location for this position at Community Health Plan of Imperial Valley?
This job at Community Health Plan of Imperial Valley is located in Imperial, CA, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Community Health Plan of Imperial Valley?
Candidates can expect a pay range of $80,000 and $100,000 per year.
What employment applies to this position at Community Health Plan of Imperial Valley?
Community Health Plan of Imperial Valley lists this role as a Full-time position.
What experience level is required for this role at Community Health Plan of Imperial Valley?
Community Health Plan of Imperial Valley is looking for a candidate with "Senior-level" experience level.
What benefits are offered by Community Health Plan of Imperial Valley for this role?
Community Health Plan of Imperial Valley offers following benefits: Health Insurance, Dental Insurance, Vision Insurance, Disability Insurance, Life Insurance, Family/Dependent Health, Paid Vacation, Paid Community Service Time, 401k Matching/Retirement Savings, and Health & Wellness Programs for this position. Actual benefits may vary depending on the employer's policies and employment terms.
What is the process to apply for this position at Community Health Plan of Imperial Valley?
You can apply for this role at Community Health Plan of Imperial Valley either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.