Audit Operations Lead (Healthcare)

Location: Remote work from the United States; listed as Connecticut Work at Home. Home internet must use cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload.

Annual salary: $62,600–$104,300 USD, depending on relevant factors including experience and geographic location; annual bonus eligibility is anticipated.

Company

hirify.global’s Evernorth Health Services division creates pharmacy, care, and benefit solutions designed to improve health and increase access to prevention and treatment.

What you will do

• Manage CMS, mock, delegation, data validation, NCQA, URAC, internal, compliance, regulatory, and operational audit activities.
• Lead audits from intake through execution, remediation, validation, and closure.
• Clarify requirements, timelines, dependencies, deliverables, and actionable next steps.
• Coordinate preparation, meetings, requirements discussions, follow-up, and delivery across multiple teams and stakeholders.
• Research unfamiliar issues, engage subject matter experts, maintain documentation, and communicate status, risks, and next steps.
• Identify and escalate risks while recommending solutions and improving SOPs, workflows, tools, and audit processes.

Requirements

• High school diploma required; bachelor’s degree preferred.
• At least 5 years of experience in client or customer support, healthcare operations, audit, compliance, project coordination, or a related area.
• Experience coordinating complex, time-sensitive work across multiple teams.
• Strong communication, organization, problem-solving, adaptability, and time-management skills.

Nice to have

• Healthcare, regulatory, accreditation, client, or internal audit experience.
• Experience developing or improving SOPs, workflows, or process documentation.
• Knowledge of prior authorization, post-service processes, reporting, or relevant eviCore systems.

Culture & Benefits

• Full-time employment with remote work from home.
• Medical, vision, dental, well-being, and behavioral health benefits available from the first day of employment.
• 401(k), company-paid life insurance, tuition reimbursement, at least 18 paid days off annually, paid holidays, and leaves of absence.
• Annual bonus plan eligibility is anticipated.
• Tobacco-free policy applies; applicants using tobacco or nicotine may be ineligible in specified states unless they enter a qualifying cessation program before starting.