Specialty Health Plans Auditor – Remote

Specialty Health Plans Auditor, Claims – Remote

Pay : $63.00–$66.00 per hour

Location : Remote (California)

Duration : 21-week contract with strong potential for conversion to permanent hire

About the Role

We’re partnering with a large, mission-driven health plan that serves millions of members across multiple lines of business. They’re seeking a Specialty Health Plans Auditor III to support their financial compliance and audit functions.

In this role, you’ll conduct and lead claims processing compliance audits for specialty programs, ensuring regulatory and contractual accuracy across medical, dental, behavioral health, vision, and other vendor services. This position requires strong analytical ability, expert knowledge of Medi-Cal, Medicare, or managed care claims, and the ability to collaborate effectively with compliance, audit, and operational teams.

Key Responsibilities

• Perform annual and ad-hoc claims audits to ensure accuracy and regulatory compliance.
• Review and report on claims processing for specialty plans and delegated entities.
• Support quarterly and annual regulatory filings and compliance submissions.
• Collaborate with internal teams and partners to implement corrective action plans and address audit findings.
• Review and update departmental policies and procedures as needed.
• Act as a Subject Matter Expert, mentoring peers and supporting process improvement initiatives.
• Develop and maintain audit templates, tools, and reporting documentation.

Required Qualifications

Preferred Qualifications