JOB SUMMARY/PURPOSE - Responsible for evaluating SHPO's adherence to key financial, operational, legal, and regulatory controls. Leads specific internal audit engagements by initiating and overseeing all fieldwork, wrap-up activities and ensuring all required activities are completed. Designs audit programs in coordination with the Compliance Department to test key controls and evaluate their effectiveness. Performs internal audit investigations throughout the health plan and compiles detailed reports with recommendations to the Compliance Officer.
DEPARTMENT DESCRIPTION - Provides oversight and direction for compliance with applicable federal/state rules and regulations and internal policies and procedures. This department is responsible for all lines of business in all service locations.
EXPERIENCE/EDUCATION/QUALIFICATIONS - Bachelor's degree in a health, business or finance related field; or equivalent combination of related education/experience required. Master's degree preferred. - Three (3) years related business experience required. Experience must include related healthcare or regulatory duties. - Experience and/or training in the following strongly preferred: - Internal auditing. - Financial and operational processes related to health insurance. - Project planning/scoping. - Government regulations specific to Centers for Medicare & Medicaid Services or the healthcare industry.
KNOWLEDGE/SKILLS/ABILITIES - Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities. - Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
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