Operations Auditor

Join our team as an Operations Auditor and play a key role in strengthening processes, ensuring compliance, and driving continuous improvement across the business.

In this role, you’ll evaluate operational practices, identify risks and inefficiencies, and partner with leaders to implement practical, value‑added solutions.

We’re looking for a detail‑oriented professional who thrives on data analysis, problem solving, and influencing positive change.

If you’re passionate about operational excellence and want to make a measurable impact, this is your opportunity to grow with us.

Apply today and help shape smarter, more efficient operations.

 

Position Summary

Independently conduct comprehensive audits to evaluate accuracy and compliance of various internal processes throughout the company as determined on a needs basis, a random rotational basis or to satisfy corporate reporting metrics.   

Essential Functions and Job Responsibilities

• Conduct prescribed audits of claims processing accuracy to support the monitoring of performance standards.

• Perform defined audits of other operational processes to meet internal oversight, departmental and business objectives.

• Complete ad hoc audits, as needed.

• Evaluate audit results against internal processes and/or controls to identify areas of non-compliance and improvement opportunities; considering compliance with prescribed operational processing guidelines, policies, state and federal laws, executed contracts and DDPA requirements, as applicable.

• Clearly document identified audit findings in a timely manner for monitoring and escalation.

• Maintain files in accordance with management policies and guidelines by obtaining and attaching all appropriate documentation to clearly establish an audit trail for each audit performed.

• Conduct independent peer reviews to assess accuracy, completeness, and adherence to department standards and internal methodologies.

• Perform other duties as assigned.

Additional Functions

• Communicate clearly and concisely, with sensitivity to the needs of others.

• Maintain courteous, helpful and professional behavior on the job; display a willingness and ability to be responsive in a warm and caring manner to all other departments.

• Maintain confidentiality of company policies and procedures, audit results, and information about clients, members, providers, and employees.

• Establish and maintain effective and respectful working relationships with co-workers and members of other departments.

Qualifications

• High school diploma required.  Some college coursework is preferred.

• Prefer three years of experience in operations auditing, or the health insurance industry to demonstrate a functional knowledge of insurance operations.    

• Strong critical thinking and analytical skills.

• Possess effective verbal and written communication skills, including effective listening skills.

• Demonstrate strong...