Grow your career at APWU Health Plan
Manager, Internal Audit
The APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking a Manager, Internal Audit to join our Compliance Department.
The Manager, Internal Audit provides strategic leadership and oversight of the internal audit function, directing a risk-based audit program that evaluates governance, risk management, compliance activities, and internal controls across APWU Health Plan.
PRIMARY ACCOUNTABILITIES:
- Leads the annual organizational risk assessment and develops, prioritizes, and oversees execution of the risk-based audit plan, aligning engagement scope, resources, and schedules with significant risks and organizational priorities.
- Establishes expectations for audit documentation and reporting; reviews findings, evaluates risk significance and root causes, and develops clear, practical recommendations supported by sufficient evidence.
- Directs complex financial, operational, and information technology audits, approves engagement approaches and testing strategies, reviews work quality, and performs in-depth analysis and testing of high-risk controls as needed.
- Presents audit conclusions, significant control weaknesses, emerging risk trends, and recommended actions to senior leadership; provides consolidated reporting on audit plan progress, outstanding findings, and corrective action status.
- Leads coordination with external auditors, regulatory bodies, and department heads on audit activities and requests; oversees follow-up procedures to track remediation commitments, validate corrective actions, and escalate overdue or unresolved high-risk findings.
- Evaluates compliance with federal and state laws, regulations, contractual requirements, accreditation standards, and organizational policies, including assessments of related governance and internal controls.
- Evaluates emerging regulatory and organizational risks, advises leadership on potential impacts, and recommends changes to audit priorities and control enhancements.
- Leads audit-related organizational initiatives, investigations, and special projects as assigned, providing risk-based guidance while preserving audit independence and objectivity.
- Escalates instances of noncompliance with internal control, security, confidentiality, and privacy policies and procedures to the Chief Compliance Officer, communicating risk implications and recommended corrective actions.
- Manages work priorities, provides coaching and development, and oversees timely delivery of high-quality audit work to direct reports.
- Performs other duties as assigned.
QUALIFICATIONS:
- A bachelor’s degree in Accounting, Auditing, Finance, Business Administration, Healthcare Administration, or a related field is required. A master’s degree is preferred. A combination of education and experience may be considered.
- Eight to ten years of progressively responsible experience in internal auditing, compliance, risk management, accounting, or a related field within healthcare is required.
Experience in a regulated healthcare environment or government healthcare program is required, with the ability to assess related regulatory, contractual, and operational risks. - Demonstrated experience leading complex audit engagements and developing risk-based audit plans is required.
- Advanced knowledge of internal auditing standards, principles, practices, risk management, and internal control frameworks, with the ability to apply applicable IIA standards and Government Auditing Standards.
- Strong strategic thinking and problem-solving skills, with the ability to evaluate complex risks, identify systemic issues, and develop practical, risk-based recommendations.
- Strong relationship-building and influencing skills, with the ability to advise senior leadership, and collaborate with internal and external partners while maintaining independence.
- Excellent written, verbal, and presentation skills.
- Strong organizational, project leadership, and resource-planning skills, with the ability to manage concurrent engagements, establish priorities, and deliver the audit plan within established timelines.
- Proficiency in Microsoft Office applications and audit management systems.
- Demonstrated ability to maintain confidentiality and exercise independent judgment in complex or sensitive matters.
- Advanced analytical skills, with the ability to interpret complex data and provide actionable leadership insights.
- Relevant professional certifications (e.g., CIA, CPA, CISA, CHIAP, or CCEP) are preferred.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Financial Analyst – Audit & Compliance
The APWU Health Plan is seeking a Financial Analyst – Audit & Compliance to join our Finance and Administration Division. This position coordinates, supports and oversees all aspects of external financial, operational and regulatory audits to ensure compliance with applicable accounting standards, contractual requirements, and government regulations.
RESPONSIBILITIES
- Monitors accounting policies, procedures and practices to ensure compliance with applicable laws, Generally Accepted Accounting Principles (GAAP), and regulatory changes.
- Manages the accounting, financial reporting, and compliance activities for the Employee Staff Pension Plan, Management Staff Pension Plan, Health and Welfare Trust, Life Insurance Plan and Health Insurance Plan.
- Prepares and records journal entries related to the Federal Plan, the Pension Plans, and Post-Retirement Benefit Plans.
- Prepares bank, investment and account reconciliations for the and Pension Plans, and the Health and Welfare Trust.
- Completes financial statements for the Pension Plans and the Health and Welfare Trust.
- Reviews proposed audit adjustments, reclassifications and findings; assists in evaluating recommendations and coordinating responses with external auditors.
- Monitors the status of audit findings, recommendations, and corrective action plans to ensure timely resolution and compliance with established deadlines.
- Provides back-up support to the Staff Accountant II and the Senior Staff Accountant for Payroll and A/P, respectively.
- Administers plan personnel policies/CBA accurately and equitably.
- Updates unit procedures on a timely basis.
- Performs other duties as assigned.
QUALIFICATIONS
- BS Degree in Accounting or Finance or equivalent combination of accounting coursework and experience
- Minimum 3-5 years’ experience in audit, accounting, or in a governmental accounting position.
- Working knowledge of the Federal Acquisition Regulations (FARS) and governmental accounting experience is desirable.
- Must be capable of obtaining/maintaining government clearance through OPM.
- Excellent analytical and organizational skills
- Strong verbal and written communication skills
- Proficient in Microsoft Office Products; Ability to learn new software programs.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
FWA Clinical Investigator
The APWU Health Plan is seeking a FWA Clinical Investigator to join our Finance and Administration Division. This position audits clinical documentation and healthcare claims to identify billing irregularities, coding inaccuracies, and suspicious billing patterns. This role plays a critical part in strengthening the operation and cost-effectiveness of the health plan’s FWA program by preventing improper payments and recovering lost revenue.
RESPONSIBILITIES
- Review electronic medical records (EMRs), clinical notes, itemized bills, and provider documentation to ensure validity, accuracy, and clinical justification of billed services.
- Analyze complex healthcare claims data to uncover suspicious provider billing behaviors, including upcoding, unbundling, duplicate billing, phantom billing, and overutilization.
- Draft evidence-based, detailed audit summaries, case briefs, and clinical rationales to support overpayment recoveries, provider corrective action plans, or referrals to OPM/OIG.
- Partner closely with investigators, data analysts, to build comprehensive evidence files for ongoing healthcare fraud investigations.
- Serve as the clinical subject matter expert for non-clinical investigators, translating complex medical workflows, documentation nuances, and provider notes into clear, actionable investigative leads.
- Other duties as assigned.
QUALIFICATIONS
- An associate or bachelor’s degree in health information management, Nursing, Healthcare Administration, Medical Coding, Criminal Justice or related healthcare field.
- Five plus years if experience performing clinical documentation reviews.
- Must have experience with fraud, waste and abuse investigations, claims auditing of medical and behavioral health services and utilization review.
- One of the following Certifications preferred:
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
- Registered Health Information Technician (RHIT)
- Registered Health Information Administrator (RHIA)
- Certified Fraud Examiner (CFE)
- Accredited Healthcare Fraud Investigator (AHFI)
- Certified Professional Medical Auditor (CPMA)
- Demonstrated proficiency with Microsoft Office 365 including Excel, PowerPoint, Outlook, SharePoint and Word.
- Must have knowledge of federal and commercial insurance regulations as well as healthcare compliance requirements (HIPAA, OPM/OIG guidelines, CMS regulations).
- Experience with Electronic Medical Records (EMR/HER) system and claims processing systems as well as data analysis and reporting tools.
- Ability to define data and information needs; compile, analyze and interpret data relative to healthcare utilization.
- Ability to identify documentation inconsistencies and billing irregularities.
- Knowledge of medical terminology, CPT and ICD10 coding, investigative techniques, analytical methodologies, and insurance and claim operations.
- Highly organized, motivated self-starter with strong analytical, critical-thinking, attention to detail and problem solving skills.
- Excellent computer skills to include Microsoft Office, Healthcare Fraud Shield software suite, QNXT software suite, savvy internet research skills and Ad hoc query and reporting.
- Excellent analytical, verbal and written communication skills.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
AI Data Business Analyst
APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking an AI Data Business Analyst to join our Information Technology Division.
The AI Data Business Analyst plays a critical role in translating business needs into data driven, AI enabled solutions that will drive strategic decisions across the APWU Health Plan.
RESPONSIBILITIES
Business & Data Analysis
- Partner with business stakeholders to understand operational challenges and translate them into clear data and analytics requirements.
- Analyze large, complex datasets to identify trends, risks, and improvement opportunities.
- Develop business cases and ROI narratives for analytics and AI initiatives that improve efficiency, reduce errors, or enhance member experience.
AI & Advanced Analytics Enablement
- Collaborate with IT to produce analysis dashboards, to create visualizations for the organization.
- Support the design, testing, and deployment of machine learning and AI enabled use cases for approved initiatives.
- Assist in monitoring models post deployment, identifying data quality issues, bias risks, or performance drift.
Governance, Compliance & Risk Awareness
- Adhere to APWUHP Compliance requirements related to data handling and reporting requirements.
- Document data sources, logic, assumptions, and limitations to support audits, transparency, and explainability.
- Participate in responsible AI and data governance processes, ensuring ethical use of analytics across the organization.
Coordinate with IT Team Leads in conjunction with the IT Project Manager, to align with organization priorities.
Work with external vendors to develop and maintain approved solutions. Scope business functional enhancement projects and validate recommended solutions to the organization.
Complete other duties as assigned.
QUALIFICATIONS
- Bachelor’s degree in business Analytics, Data Science, Information Systems, Statistics, Computer Science, or a related discipline, or equivalent practical experience.
- 5+ years of experience in data analysis, business analysis, or analytics roles, preferably in healthcare, insurance, or other regulated environments.
- Hands‑on experience working with structured datasets and analytical tools to support business decision‑making.
- Experience collaborating with cross‑functional teams, including IT, compliance, and operations.
- Excellent technical and analytical skills, as well as exceptional verbal and written communication skills. Ability to render and write business requirements such as technical documentation and business decision documentation.
- Proficiency in requirements gathering – effectively translating business needs as expressed by users into workable specs, estimating time\duration to complete and implement the solution.
- Strong SQL and data analysis skills; experience with BI and visualization tools.
- Familiarity with machine learning or AI concepts (predictive modeling, NLP, automation), with emphasis on business application rather than model development.
- Ability to clearly communicate insights, risks, and recommendations to non‑technical audiences.
- Experience with healthcare claims, enrollment systems, or payer data preferred.
- Exposure to model governance, audit support, or regulatory reporting preferred.
- Experience supporting analytics during high volume periods such as Open Season preferred.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Note to agencies
We do not accept unsolicited resumes from third-party vendors. Only resumes received from contracted agencies/vendors will be considered. Unsolicited resumes sent to APWU Health Plan will not be recognized and such agency will have no recourse from APWU Health Plan.