Auditor

• Develop and implement effective business solutions through research, audit, and data and/or business-process analysis
• Audit and validate routine pre- and post-payment claims for correct adjudication and compliance
• Audit provider data loaded into claims processing systems
• Document and report audit results
• Research claims and enrollment discrepancies related to provider data
• Manage provider-data-management-related projects requiring advanced knowledge of provider files and their relationship to claims processing systems
• Review and support the claims process for medical review and cost-saving initiatives
• Maintain department statistics for quality improvement indicators, regulatory agencies and certification bodies
• Perform routine and moderately complex audits on medical review claims to identify exceptions
• Research reviewed-claim issues to determine origins and appropriate resolutions
• Summarize findings and recommendations in reports and distribute them to management
• Communicate audit and review results to the claims department to improve claims processing and resolutions
• Provide qualified data for training programs, policies and procedures
• Maintain current working knowledge of Health Net products, policies, procedures, coding, and applicable industry standards

Senior Quality Auditor

• Lead and support Information Systems Audit engagements
• Identify business process and IT risks, determine risk severity and business impact, and develop audit tests of controls
• Assess technology control environments for SOX, regulatory, and organizational policy compliance
• Evaluate technology processes and risks and lead control design and operating effectiveness testing
• Prepare audit work papers documenting tests, evidence, and results
• Draft, finalize, and present audit engagement results, findings, recommendations, and associated risks to IT Management and stakeholders
• Update audit programs and questionnaires and recommend enhancements to Internal Audit policies and procedures
• Support Enterprise Risk Management risk assessments and projects
• Maintain professional and technical knowledge through workshops, publications, networks, and professional societies
• Prepare special audit and control reports by analyzing operating information and trends
• Contribute to Internal Audit team efforts and train team members as needed
• Perform other duties and special projects as assigned

Senior IT Auditor

• Lead accredited certification, assurance, validation, and verification assessments across diverse industries
• Help organizations identify opportunities to improve environmental, health, safety, quality, and operational performance
• Provide objective assessments supporting compliance, risk management, and continuous improvement
• Contribute technical leadership, knowledge sharing, and client relationship building
• Support ESG and sustainability initiatives through assurance services
• Plan, conduct, and manage audits, including preparation, site activities, stakeholder interviews, evidence review, reporting, and assessment conclusions
• Deliver clear, accurate, and timely assessment reports and recommendations
• Maintain technical expertise across applicable standards, regulations, and industry best practices
• Support continuous improvement of ERM CVS methodologies, competencies, and operational processes
• Share knowledge and technical expertise across the global ERM CVS team
• Build trusted client relationships and represent ERM CVS during engagements
• Identify opportunities to support client needs and contribute to business development
• Coach and support colleagues in audit delivery, technical interpretation, and assessment best practices
• Contribute to ERM CVS's technical excellence, integrity, and client service

Lead Auditor

• Lead accredited certification, assurance, validation, and verification assessments across diverse industries
• Help organizations improve environmental, health, safety, quality, and operational performance
• Provide objective assessments supporting compliance, risk management, and continuous improvement
• Contribute technical leadership, knowledge sharing, and client relationship building to ERM CVS growth
• Support ESG and sustainability initiatives through assurance services
• Plan, conduct, and manage audits, including preparation, site activities, stakeholder interviews, evidence review, reporting, and conclusions
• Deliver clear, accurate, and timely assessment reports and recommendations
• Maintain technical expertise across applicable standards, regulations, and industry best practices
• Support continuous improvement of ERM CVS methodologies, competencies, and operational processes
• Share knowledge and lessons learned across the global ERM CVS team
• Build trusted client relationships and represent ERM CVS professionally
• Identify client support and business development opportunities with leadership and partners
• Coach and support colleagues in audit delivery, technical interpretation, and assessment best practices
• Contribute to ERM CVS’s technical excellence, integrity, and client service

• Lead accredited certification, assurance, validation, and verification assessments across diverse industries
• Help organizations identify opportunities to improve environmental, health, safety, quality, and operational performance
• Provide objective assessments supporting compliance, risk management, and continuous improvement
• Contribute to ERM CVS growth and development through technical leadership, knowledge sharing, and client relationship building
• Support ESG and sustainability initiatives through assurance services
• Plan, conduct, and manage audits, including preparation, site activities, stakeholder interviews, evidence review, reporting, and assessment conclusions
• Deliver clear, accurate, and timely assessment reports and recommendations
• Maintain technical expertise across applicable standards, regulations, and industry best practices
• Support continuous improvement of ERM CVS methodologies, competencies, and operational processes
• Share knowledge, lessons learned, and technical expertise across the global ERM CVS team
• Build trusted client relationships and represent ERM CVS professionally
• Identify opportunities to support client needs and contribute to business development activities
• Coach and support colleagues in audit delivery, technical interpretation, and assessment best practices
• Contribute to ERM CVS's reputation for technical excellence, integrity, and client service