Fallon Health

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Internal Auditor II

Internal Auditor II

Job ID 
# Positions 
Posted Date 
Internal Audit

More information about this job


About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.


Brief Summary of Purpose:

Under the direction of the Audit Director or lead auditor, the Internal Auditor II will play a key role in implementing the annual audit plan. The Internal Auditor II conducts high risk audits and related projects (financial, operational and regulatory in nature), documents and conveys results and makes recommendations.


Under the direction of the Audit Director or lead auditor, the auditors will execute on the following:

  • Assist management on high risk audits, projects, as well as special requests.
  • Independently plan, design, perform all aspects of audits following departmental standards and procedures, including walkthrough of processes, setting objectives, defining scope, designing tests and performing the audit testing.
  • Perform risk assessments, including identification, evaluation, and documentation of business risks and controls.
  • Analyze audit evidence to provide management with an evaluation of the adequacy of financial and operational controls and make recommendations for improvement.
  • Communicate effectively with all levels of management; including executive management to ensure full understanding of objectives, risks, controls, and observations. Prepare clear and concise audit reports and other communications.
  • Complete ad hoc projects as requested by management.
  • Support regulatory Center of Medicare and Medicaid Services (CMS) Audits and internal control testing; including attending meetings with CMS Regulatory Auditors and external audit firms.
  • Conduct high risk audits including compliance (CMS), financial and operational, Model Audit Rule control audits, claims and contracting audits, provider audits, functional audits and others as directed.
  • Lead fraud investigations into those committing suspicious acts against FH, including eligibility audits of group employers and individuals.
  • Lead internal audits of operations, and consult with process management on solutions.
  • Work independently on audit engagements.
  • Prepare working papers and written audits reports.
  • Hold preliminary discussions of audit results with business partners to verify facts and discuss recommendations. This includes attending meetings with all levels of management; including executive management to ensure full understanding of objectives, risks, controls, and observations.
  • Appraise the adequacy of the corrective action taken and work collaboratively with business partners to assist in developing business process changes to address recommendations.
  • Apply data mining technology to audits/projects.
  • Support the Director of Internal Audit in implementing the annual audit plan.
  • Assist Senior Auditors with complex audits, as needed.



Bachelor’s degree from a four year college or university in accounting, or finance or business administration



Other Professional certification (CPA or CIA), or master’s degree a plus.




  • 3 to 5 years of experience in a financial service environment, preferably health care experience or experience in internal auditing, public accounting or regulatory compliance.
  • Model Audit Rule / Sarbanes-Oxley Act (SOX) testing preferred, but not a requirement.
  • Ability to work on multiple, concurrent projects, as part of a team or independently, and research, understand, and evaluate the company’s operations, rules and regulations.
  • Demonstrate a high level of personal integrity and reflect an appropriate level of judgment, maturity, and confidentiality.
  • Successfully interact with all levels of personnel in a positive, constructive manner.
  • Strong analytic skills and an inquisitive personality.
  • Effective oral and written communications with management
  • Ability to travel as necessary, 5%