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Senior Auditor

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POST DATE 9/15/2016
END DATE 11/15/2016

Tufts Health Plan Watertown, MA

Watertown, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


The Audit Senior position reports to the Audit Manager and provides management for the audit activities assigned. The position supports the Audit Manager in his/her leadership of the functional area of business they audit and is responsible for the efficient and timely delivery of all audit activities related to the function line of business which he/she supports as well as department strategic initiatives.

The Senior (Compliance) Auditor will conduct regulatory audits activities to evaluate compliance with the federal and state regulations, including our Centers of Medicare and Medicaid Services (CMS) Medicare Advantage (MA) and Medicare and Medicaid Program (MMP) programs, as well as our First Tier, Downstream, and Related Entities (FDRs). The Senior (Compliance) Auditor will require considerable knowledge of the business operations and the policy requirements associated with them, including the Code of Federal Regulations, Medicare Managed Care Manuals, and the State Medicaid Manuals.

* Performs audit activities independently under the direction of the Audit Plan Owner or supports the Auditor-In-Charge across all phases of the audit (i.e. Planning, Fieldwork, Reporting) to ensure audits are completed timely, with quality, and according to department guidelines, methodology, and approach.
* Works collaboratively with team, business and operational areas to perform audit activities assigned and develops remediation plans for issues identified.
* Communicates results of audit activities with audit management and facilitates the development of management action plans to address any deficiencies identified.
* Responsible for completing all performance and development objectives set forth annually.
* Supports Management request regarding the internal control environment.
* Performs other duties and or special projects as assigned or required.


* Bachelor's degree, advanced degree preferred
* 3+ years of internal or external audit experience


* Healthcare Industry Experience; Preferably Healthcare Insurance experience.
* Knowledge of the operation, procedures and policies of assigned business units. Strong familiarity with their specific business processes and transactions

Previous experience in the traditional Medicare, Medicare Advantage, or State regulatory environment is strongly preferred.
* Knowledge of Generally Accepted Audit Standards, IIA standards, accounting and auditing sampling and testing methodologies.
* Knowledgeable and experienced in benchmarking and process improvements
* Certified in Healthcare Compliance (CHC), strongly preferred

Certified Internal Auditor (CIA) designation, strongly preferred

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.


Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled


Founded in 1979 as a non-profit health maintenance organization (HMO), Tufts Health Plan is one the country's largest HMO offering a full array of healthcare coverage options to individual consumers and employer groups. Tufts Health Plan has received high marks for its quality from a variety of third parties including U.S News & World Report and Newsweek.