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.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.