Operations Audit Manager

Job Summary

The Operations Audit Manager leads the development, execution, and oversight of risk-based audit plans to ensure compliance with federal and state health plan regulatory requirements. The role conducts internal audits, manages corrective actions, and coordinates all aspects of external regulatory examinations, including ACA, Medicare, and state-level compliance reviews. The manager serves as a primary liaison with agencies such as CMS, PID, DOBI, and other regulators, providing technical guidance, preparing audit responses, and ensuring accurate and timely submissions. This role also supports leadership through clear communication of findings, risks, and recommended actions.

Responsibilities

External Audit & Regulatory Examination Management

• Serve as the primary Operations liaison in for external examinations, overseeing documentation, evidence collection, and formal submissions.
• Support complex regulatory exams conducted by CMS, PID, DOBI, and other agencies, ensuring timely, accurate, and complete responses.
• Participate in audit status meetings, opening/closing conferences, and interim touchpoints with business, legal, and executive stakeholders.

Reporting & Communication

• Communicate findings to management and, when needed, senior leadership or the Audit & Risk Management Committee.
• Identify, escalate, and track issues in a timely and appropriate manner.

Leadership & Collaboration

• Manage audit staff and oversee day-to-day operations of the audit function.
• Work cross-functionally with Claims, Provider Operations, Sales, and other business areas to assess escalated issues.
• Lead or work independently depending on project scope, managing multiple concurrent engagements within established timeframes.

Qualifications

Bachelor's degree in accounting, Finance, Business, or a related field; a combination of education and relevant experience is acceptable.

• Advanced degree or professional certification (CPA, CIA, CISA, JD) preferred but not required
• 5-8 years of experience in regulatory audit, compliance, or risk management, with strong preference for experience managing external regulatory examinations in healthcare or insurance.
• Strong knowledge of CMS, state, and federal regulatory requirements, including Medicare, ACA, and state compliance standards.
• Excellent analytical, oral, and written communication skills with the ability to interpret and explain complex regulatory requirements.
• Highly organized, detail-oriented, and able to manage multiple projects concurrently within established timelines.