Internal Audit Manager – Health Insurance

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.