Insurance auditor vs compliance auditor

Differences between insurance auditor and compliance auditor duties and responsibilities

Insurance auditor example responsibilities.

• Manage the collection, analysis and verification of managerial payroll information to detect fraud and/or unethical practices.
• Prepare the audit report as prescribed by the insurance company within the time allow and within NCCI and ISO rules.
• Modify claim files upon customer request using proprietary software under strict HIPAA guidelines.
• Provide contract audit services to monitor the field sales force compliance with internal policies on promotional spending on healthcare providers.
• Audit paperwork to ensure products are produced within company and FDA specification.
• Develop and implement the recovery audit program for post-payment audit of dental Medicaid programs.
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Compliance auditor example responsibilities.

• Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
• Identify any issues that do not conform to CFR, ICH guidelines and corporate expectations.
• Research HIPAA information from CMS website in order to determine correct revisions for policies and procedures and develop company-wide communications.
• Coordinate team meetings, maintain calendars, support team with PowerPoint presentations.
• Prepare and perform in-house presentations (both in person and using JoinMe) using PowerPoint.
• Evaluate the level of compliance with company policy, GAAP, contract requirements and applicable rules and regulations.
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