Internal Audit Manager – Health Insurance

Description

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

The Internal Audit Manager is responsible for leading and executing risk-based internal audit activities across health insurance operations. This role plays a critical part in evaluating governance, risk management, and internal control effectiveness, including compliance with regulatory requirements, the Model Audit Rule (MAR) and Own Risk and Solvency Assessment (ORSA). Experience in Medicare Advantage is strongly preferred due to regulatory complexity and heightened oversight. 

ESSENTIAL FUNCTIONS:  

• Plan, lead, and execute complex internal audit engagements across health insurance operations, including claims, provider relations, utilization management, finance, compliance and FDR functions. 
• Evaluate the adequacy and effectiveness of internal controls, operational processes, and risk management practices in accordance with professional auditing standards. 
• Plan, lead and execute audits and testing related to the Model Audit Rule (MAR). 
• Lead and support development of the Own Risk and Solvency Assessment (ORSA) annual process and reporting, regulatory examinations, and external audits. 
• Prepare ORSA regulatory reports. 
• Assess compliance with federal and state regulations applicable to health insurers, including CMS requirements for Medicare Advantage programs. 
• Develop audit scopes, risk assessments, and work programs using a risk-based audit approach. 
• Prepare audit reports and present findings and remediation plans to senior management. 
• Monitor corrective action plans and validate remediation of audit findings. 
• Provide advisory support on risk mitigation, control design, and process improvements. 
• Manage, coach, and mentor audit staff or co-sourced resources as applicable. 

Requirements

QUALIFICATIONS AND REQUIREMENTS:

JOB REQUIREMENTS:

Required Qualifications

• Bachelor’s degree in Accounting, Finance, Business Administration, or a related field. 
• Seven or more years of internal audit, external audit, or risk management experience within the health insurance industry. 
• Demonstrated experience with ORSA and Model Audit Rule (MAR) requirements. 
• Strong knowledge of internal control frameworks and risk management principles. 
• Strong analytical, written, and verbal communication skills. 
• Preferred Qualifications 
• Medicare Advantage experience. 
• Professional certification such as CPA, CIA, CISA, or similar. 
• Experience interacting with regulators, external auditors, or state insurance departments. 
• Prior experience leading or mentoring audit staff. 

Member-Centric Impact Statement

The Compliance Department and Internal Audit exist to protect our members by proactively identifying risks and maintaining rigorous oversight to ensure our organization operates in line with regulatory standards, ethical behavior and accountability. Compliance and Internal Audit, through proactive organizational oversight, champions processes that foster regulatory compliance and enhances member safety, privacy and trust. Our commitment to doing what’s right helps create a reliable, respectful, and member focused experience for all individuals we serve.  

Zing Health offers the following benefits:

•  A competitive salary based on the market  
•  Medical, Dental, and Vision  
•  Employer-Paid Life Insurance  
•  Paid Maternal Leave  
•  Paid Paternal Leave  
•  401(K) match up to 4%  
•  Paid-Time-Off  
•  Employee Assistance Programs  
•  Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.  

The role may involve occasional travel to the corporate office and participation in company engagements.