Los Angeles, CA, USA
10 days ago
Senior Health Plan Auditor
Kforce has a client in Los Angeles, CA that is seeking a Senior Health Plan Auditor to join their Financial Compliance team. Summary: This is a hybrid role based in Los Angeles and plays a critical part in monitoring financial solvency and claims processing compliance across our delegated health plan partners and vendors. This position offers an opportunity to work at the intersection of healthcare, finance, and compliance - helping ensure vulnerable and low-income communities in LA County continue to receive timely and high-quality care. Key Responsibilities: * Lead audits and financial analyses for specialty health plans and vendors to ensure compliance with regulatory and contractual obligations * Manage quarterly and annual claims submissions to the Department of Managed Health Care (DMHC) for client and delegated entities * Develop, maintain, and review departmental policies, procedures, audit templates, and workpapers * Serve as the primary liaison for CMS audit activity and financial compliance reporting * Support the design and implementation of corrective action plans, audit reporting tools, and special projects * Mentor junior team members and contribute to cross-functional collaboration across the organization
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