Internal Auditor
Fallon Community Health Plan - Worcester, MA

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About Fallon Community Health Plan:

Founded in 1977, Fallon Community Health Plan is a nationally recognized, not-for-profit health care services organization. From traditional health insurance products available throughout Massachusetts for all populations, to innovative health care programs and services for independent seniors, FCHP supports the diverse and changing needs of all those it serves. FCHP has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fchp.org.

Position Overview:

The Internal Audit Department (IA) at FCHP is committed to protecting FCHP by conducting independent and objective internal audits and assessments of its operational, financial and compliance controls. IA reports administratively to the Chief Financial Officer and functionally to the Audit & Compliance Committee, and plays a key role in auditing risks identified in FCHP’s enterprise risk management plan. The Internal Auditor II plays a key role in implementing the annual audit plan. The Internal Auditor II conducts audits and related projects (financial, operational and regulatory in nature), documents and conveys results and makes recommendations.. This position requires a professional with excellent analytical and technical skills, audit experience and strong communication skills. A desire to work in a collaborative environment with audit responsibilities and to support Fallon Community Health’s business objectives is critical.

Responsibilities
  • Conduct ongoing audits including financial operational control audits, claims and contracting audits, provider audits, functional audits and others as directed.
  • Lead internal audits of operations, and consult with process management on solutions.
  • Work independently on engagements, including financial/operation/regulatory internal audits.
  • Prepare working papers and written audits reports.
  • Hold preliminary discussions of audit results with business partners to verify facts and discuss recommendations.
  • Appraise the adequacy of the corrective action taken and work collaboratively with business partners to assist in developing business process changes to address recommendations.
  • Apply data mining technology to audits/projects.
  • Support the Director of Internal Audit in implementing the annual audit plan.
  • Assist Senior Auditors with complex audits, as needed.
  • Lead fraud investigations into those committing suspicious acts against FCHP, including eligibility audits of group employers and individuals.

Qualifications

Education : Bachelor’s degree is required; other professional certification or masters degree a plus

Certification: CIA or CFE a plus

Experience: Minimum of three years internal audit and/or related experience in a financial and/or insurance environment - preferably Healthcare; experience working with government programs (Medicare and Medicaid) or experience in a consulting environment a plus. Some experience in financial and operational auditing.

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