About us Community Health Plan of Imperial Valley (CHPIV) is committed to improving the health and well-being of our community by offering accessible, high-quality, and culturally sensitive healthcare services. We are a local health plan dedicated to making a positive impact through education, outreach, and innovative care. The Compliance Auditor plays a critical role in advancing the mission of Community Health Plan of Imperial Valley (CHPIV) by ensuring that administrative/non-clinical functions performed by delegated entities are in full compliance with regulatory, contractual, and clinical standards. About the role Our new Compliance Auditor will do the following: • Evaluate process compliance and operational workflows for internal and delegated functions. • Identify systemic issues and contribute to corrective action planning. • Monitor regulatory metrics and reporting to committees. • Conduct audits of non-clinical delegated functions including claims, encounters, credentialing, language assistance services, and program effectiveness. • Review and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and materials. • Assess compliance with DHCS, DMHC, CMS, and NCQA regulatory requirements, as well as contractual obligations. • Identify gaps in documentation, workflows, and performance that could result in audit findings or compliance risks. • Monitor corrective action plans and validate the resolution of findings to ensure sustained compliance. • Support enterprise-wide verification studies and external audit readiness, including pre-audit documentation review and file validation. • Collaborate with internal departments and external delegates to ensure alignment and operational consistency. About our next team member Our new Compliance Auditor will have the following: • Bachelor’s degree in Healthcare Administration, Public Health, Business, or a related field; equivalent experience may be considered in lieu of degree • Minimum of 3-4 years of experience in compliance, auditing, or regulatory oversight within a managed care or healthcare delivery environment. • Familiarity with Medi-Cal and/or Medicare regulatory requirements (DHCS, DMHC, CMS). • Strong understanding of delegated functions such as claims, encounters, credentialing, and language assistance services. • Demonstrated ability to review and interpret policies, procedures, and operational workflows. • Excellent organizational, analytical, and time management skills with the ability to manage multiple priorities. • Strong written and verbal communication skills, including the ability to draft audit findings and compliance reports. • Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and experience working with audit tracking systems or similar tools. • Ability to work independently and collaboratively in a fast-paced, deadline-driven environment. Our commitment to you • A competitive salary of $80,000-$100,000/ year • Health, dental, and vision insurance that is paid 85% for you and your family • Paid life and disability insurance • A retirement plan with a generous match • Paid time off • A chance to make a real difference in the Imperial Valley community We are an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.