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Fallon Health Internal Auditor - Health Care Services and Products! in Worcester, Massachusetts


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 fallonhealth.org.

Brief Summary of Purpose :The Internal Audit Department (IA) at Fallon Health is committed to protecting Fallon Health by conducting independent and objective internal audits and assessments of its operational, financial and compliance controls. IA reports administratively to the Chief Compliance Officer and functionally to the Audit & Compliance Committee, and plays a key role in auditing risks identified in the organization. The Internal Auditor plays a key role in implementing the annual audit plan. The Internal Auditor conducts audits and related projects (financial, operational and regulatory in nature), documents and conveys results and makes recommendations. This position requires a professional with analytical and technical skills, and strong communication skills. A desire to work in a collaborative environment and ability to interact with all levels within the organization.



  • Assist management on audits, projects, as well as special requests. This could include the completion of claims, operational, financial and compliance audits, as well as, testing of internal controls (Model Audit Rule).

  • 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.

  • Analyze audit evidence to provide management with an evaluation of the adequacy of financial, operational and regulatory controls and make recommendations for improvement. This could include claims testing for payment accuracy and financial accuracy.

  • Communicate effectively with all levels of management to ensure full understanding of objectives, risks, controls, and observations.

  • Ability to work in a fast-pace environment and can readily adapt to changes within the organization or department.

  • Prepare clear and concise audit reports, corrective action plans, and other communications.

  • Complete ad hoc projects as requested by management. This may include researching potential fraud, waste or abuse related inquires

  • The primary focus of this role will be to assist management on audits, projects, as well as special requests; independently perform all aspects of audits following departmental standards and procedures.

  • Assisting other auditors with internal audit testing.

  • Identify control weaknesses within the processes, communicate findings to process owners, and make recommendations for remediation.

  • Support the Audit Department in implementing the annual audit plan.



Bachelor’s degree is higly preffered, preferably in Business Administration with a concentration in Finance/Accounting or equivalent work experience;Master’s degree a plus

License/Certifications :

Certificate of Professional Coding (CPC), preferred.

Other Professional certification (CIA), a plus.


  • 1 to 3 years of relevant work experience can be experience working in corporate environment, preferably in health care environment and/or internal audit experience. Experience working in a government program (Medicare and Medicaid), a plus.

  • Proven ability to effectively communicate with all levels within an organization.

  • Possesses a high degree of integrity and confidentiality based on exposure to personal and confidential information.

  • Strong analytical ability and organizational skills

  • High level understanding of internal controls

Job ID 5793

# Positions 1

Category Internal Audit