Internal Auditor at LEAD Enterprise Support Company Limited

Job Summary

The Internal Auditor ensures that all financial, operational, and regulatory processes within the HMO comply with the National Health Insurance Authority (NHIA) Act, internal policies, and industry standards. The role involves conducting routine audits, identifying risks, preventing fraud, improving internal controls, and ensuring that provider claims, enrollee management processes, and financial transactions are accurate, transparent, and compliant.

Key Responsibilities

Financial and Operational Audit

• Conduct periodic audits of all financial transactions, including premiums, capitation, claims, and provider payments
• Review financial statements and accounting systems for accuracy and compliance with standards
• Verify revenue inflows, expenditures, reconciliations, and budget performance

Compliance & Regulatory Monitoring

• Ensure strict compliance with the NHIA Act, 2022, NHIA guidelines, and HMO regulatory obligations
• Review internal controls and procedures to ensure alignment with statutory requirements
• Monitor adherence to audit recommendations

Claims & Medical Operations Audit

• Audit hospital and healthcare provider claims to detect fraud, abuse, and irregularities
• Review pre-authorizations, case management records, and enrollee utilization patterns
• Ensure that tariff payments, encounter data, and reimbursement processes are properly documented

Risk Management

• Identify operational, financial, and compliance risks within the organization
• Recommend risk mitigation strategies and improvements in control mechanisms
• Conduct fraud-risk assessments and support investigations where necessary

Performance Audit

• Audit internal departments (IT, Provider Relations, Call Center, Enrollment, Underwriting, Finance, etc.) for process efficiency
• Evaluate the adequacy of internal controls and recommend improvements

Reporting & Documentation

• Prepare comprehensive audit reports with findings, recommendations, and action plans
• Maintain detailed audit documentation and working papers
• Present audit findings to management and relevant stakeholders