Operations & Compliance Auditor

Job Description

Job Description

Operations & Compliance Auditor

Healthcare is increasingly unaffordable for many Americans. For those who can afford it, they are in a health insurance system that has become more confusing, restrictive, and lower value with each passing year. Here at WeShare our mission is to bring better healthcare to America at a better price. We offer consumers a member-to-member health sharing program that is much more cost effective than standard health insurance while providing access to over 1.2 million physicians across the country. Come join us on this important journey to create the next generation of healthcare!

WeShare is a rapidly growing faith-based nonprofit that strives to do good while delivering great and affordable healthcare. The company is led by senior executives with an extensive background in both for-profit and not-for-profit enterprises. If you have a bias for action, enjoy challenges, and love creating impact in a massive industry, WeShare 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

UHSM 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.