Operations & Compliance Auditor in Orange, California at United Faith Ministries Inc
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Job Description
Operations & Compliance Auditor
Healthcare is increasingly unaffordable for many Americans. Most people believe they have two choices: increasingly expensive, restrictive employer insurance, or an ACA plan that keeps getting pricier. Many don't know there's a third, smarter option.
WeShare Health is that option.
WeShare Health’s mission is to make healthcare simpler, more affordable, and more human. We're a nonprofit, faith-inspired healthcare sharing organization where members contribute monthly to share one another's eligible medical expenses. We're proudly not insurance, and that's the point.
Members access a national network of 1 million physicians at 30 to 60 percent less than comparable traditional insurance. Since 2018, WeShare Health has served more than 100,000 members and shared more than $50 million in medical expenses. Our purpose is clear: people before profit.
WeShare Health is led by senior executives with deep experience across for-profit and nonprofit enterprises. We’re rated 4.6 out of 5 on Google Reviews, rated 4.7 on Trustpilot by members and certified as a Great Place To Work® by our employees. If you have a bias for action, enjoy challenges, and want to challenge the status quo to make an impact in a massive industry, WeShare Health might be the place for you!
About this role
The Operations & Compliance Auditor ensures accuracy, compliance, and efficiency across call-center and operational workflows. This role conducts advanced, risk-based audits across multiple communications channels, identifies systemic gaps, and provides strategic insights that protect revenue, data integrity, and member experience.
Operating with minimal supervision, the auditor serves as a subject matter expert, escalation resource, and partner to leadership on quality, compliance, and process improvement initiatives.
Key Responsibilities
Quality Oversight & Multi-Channel Auditing
- Conduct risk-based audits across calls, case documentation, emails, texts, escalations, exceptions, and retention/saves
- Perform high-risk and escalated audits requiring independent judgment and regulatory awareness
- Identify systemic process gaps, compliance deviations, terminology inconsistencies, operational risks, and provide actionable recommendations
- Perform peer-to-peer audits and audit the auditors
Operational Expertise & Escalation Support
- Serve as a subject matter expert for eligibility, application outcomes, cancellations, reinstatements, saves, and compliance workflows
- Act as an escalation resource for complex or high-risk cases
- Ensure adherence to internal protocols, documentation standards, and compliance requirements
- Proactively identify and resolve operational or compliance issues with a solutions-oriented approach
Trend Analysis & Strategic Insight
- Analyze audit trends and performance metrics to support leadership decision-making
- Identify recurring errors, blind spots, and systemic issues and contribute to process improvement planning
- Provide complete, accurate reporting with clear recommendations
- Participate in calibration sessions to ensure consistent scoring
- Detect errors impacting revenue, billing accuracy, eligibility, or member records
- Support special projects and implementation of safeguards that protect revenue and reputation
Reporting, Documentation, & System Optimization
- Maintain accurate audit logs and documentation
- Support development of audit scorecards, QA workflows, and reporting frameworks
- Participate in system optimization initiatives to improve operational efficiency
Reliability & Performance
- Consistently meet or exceed KPIs with minimal supervision
- Demonstrate strong follow-through, confidentiality, and discretion with sensitive data
- Maintain a solutions-oriented mindset in resolving operational challenges
Required Qualifications
- HS Diploma/GED or higher
- 1+ year in QA, auditing, compliance review, call-center QA, or customer service
- Experience auditing calls, written correspondence, and case documentation
- Strong analytical skills with trend and root-cause identification
- High attention to detail, risk assessment ability, and independent judgment
- Strong written and verbal communication skills
- Proven reliability, confidentiality, and ability to provide objective feedback
- Excel proficiency and experience creating structured reports
- Demonstrated process-improvement and system-optimization experience
- Strong organizational skills and ability to work with minimal supervision
Preferred Qualifications
- Experience in healthcare, health-sharing, insurance, or non-profit environments
- Familiarity with compliance frameworks and HIPAA
- Bilingual (Spanish/English) and tech-savvy
What we offer
- Competitive hourly and benefits package, including health, life dental, and vision insurance, 403(b) with company match, and time off
- The chance to make a meaningful impact in the lives of individuals and families seeking affordable, faith-based healthcare solutions
- Great culture where you work with the founders and key stakeholders in a relaxed, but innovative atmosphere
WeShare Health is an Equal Opportunity Employer. Our business is fast-paced and will continue to evolve. As such, the duties and responsibilities of this role may be changed as directed by the Company at any time to promote and support our business needs. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, protected veteran status, or any other basis protected by applicable law and will not be discriminated against on the basis of disability.