To support comprehensive Medical Loss Ratio (MLR) examinations remotely, the full-time Senior Compliance Auditor will analyze documentation, perform attribute testing, and review compliance with state and federal regulations in the healthcare and insurance sectors.
Key responsibilities
Conduct analytical reviews of documentation to ensure compliance with MLR calculations and rebate distributions
Perform testing of premium and claims transactions for accuracy and completeness related to MLR calculations
Review Quality Improvement Activity expenses and Pharmacy Benefit Manager contracts for regulatory compliance
Required qualifications
Minimum 2+ years of experience in auditing or accounting within healthcare, insurance, or related fields
Experience with MLR and related rebate requirements is required
Bachelor's Degree in Accounting or Finance preferred
CPA, CIA, CFE, or AFE certifications preferred but not required
Proficiency in software tools such as TeamMate, ACL/Access/Tableau, and MS Excel