The Senior Manager, Auditing, Monitoring & Vendor Oversight is responsible for providing independent, second-line oversight and assurance over Sendero Health Plan’s compliance with federal and state regulatory requirements applicable to a Qualified Health Plan This role evaluates whether compliance controls—implemented and maintained by operational areas and supported by the Senior Manager, Compliance—are designed effectively and operating as intended.

The Senior Manager, Auditing, Monitoring & Vendor Oversight conducts risk-based compliance monitoring, auditing, and vendor oversight activities, validates corrective actions, and identifies systemic compliance risks. This role works in close coordination with the Senior Manager, Compliance, while maintaining appropriate independence to support objective findings, credible escalation, and regulatory defensibility under the Affordable Care Act (ACA), Centers for Medicare & Medicaid Services (CMS) Marketplace regulations, and Texas Department of Insurance (TDI) requirements.

Essential Functions
Compliance Monitoring & Auditing (Second Line Assurance)
• Execute risk based compliance monitoring and audit activities in accordance with approved methodologies
and annual work plans.
• Independently assess compliance controls across internal operations and vendor managed functions.
• Conduct reviews across key operational areas, including:
o Enrollment and eligibility
o Claims processing and payment accuracy
o Appeals and grievances
o Marketing and broker oversight
o Privacy and information security
o Delegated and downstream entities
• Maintain complete, accurate, and defensible audit documentation and workpapers.

Risk Identification & Independent Evaluation
• Identify control weaknesses, compliance gaps, and regulatory risks through monitoring and audit activities.
• Perform independent root cause analysis and assess risk severity.
• Escalate significant findings in accordance with compliance governance and risk management protocols.
Validation of Remediation & Issue Closure
• Independently validate corrective actions implemented by business units and coordinated by the Senior Manager, Compliance.
• Conduct follow up testing to confirm remediation effectiveness and sustainability.
• Support evidence based issue closure decisions.

Vendor & Delegated Entity Oversight (Independent Testing)
• Conduct compliance monitoring and audit reviews of vendors and delegated entities.
• Assess vendor adherence to contractual, regulatory, and documentation requirements.
• Identify vendor related risks and systemic issues and communicate findings to Compliance leadership and Vendor Management.
• Validate vendor remediation efforts following identified findings.
Audit Readiness & Examination Support
• Support CMS, TDI, and other regulatory audits or examinations through independent oversight and documentation.
• Provide objective assessments during regulatory reviews without assuming operational ownership of responses.
• Identify audit trends and lessons learned to inform future monitoring activities.

Coordination with Compliance Execution
• Coordinate closely with the Senior Manager, Compliance to ensure clarity of roles and responsibilities.
• Share findings, trends, and risk insights to support operational remediation efforts.
• Maintain independence by refraining from designing, implementing, or owning compliance processes.

Reporting & Communication
• Prepare monitoring and audit reports summarizing findings, risk levels, and remediation status.
• Provide periodic reporting to compliance leadership on trends, recurring issues, and vendor performance.
• Support leadership reporting to governance committees as requested.

Knowledge, Skills and Abilities:

• Risk based compliance monitoring and auditing
• Independent judgment and objectivity
• Vendor and delegated entity oversight
• Root cause analysis and validation
• Clear reporting and escalation
• Cross functional collaboration

Required Education:

• Bachelor's Degree (higher degree accepted) in healthcare administration, business, accounting, law, or a related field.

Required Experience:

• 6 years years of experience in healthcare compliance monitoring, auditing, risk management, or vendor oversight.
• Working knowledge of ACA, CMS Marketplace, Medicaid requirements, and Texas Department of Insurance regulatory frameworks. 
• Experience conducting compliance monitoring or audits in regulated healthcare environments. 
• Strong analytical, investigative, and documentation skills.