Resp & Qualifications
PURPOSE:
The External Audit Consultant is a subject matter expert liaison, both within the internal business community and externally with Insurance Regulatory Agencies. The External Audit Analyst will interact with all levels of management, and external regulators. This includes handling confidential and sensitive information regarding audit inquiries and outcomes.
ESSENTIAL FUNCTIONS:
- Plan, organize and lead external audit projects of varying complexity and length related to regulatory market conduct examinations, BCBSA and audits, and regulatory investigations, surveys, and inquiries. Lead the successful completion of operational, financial, regulatory, compliance and BCBSA and program audits through the direction and oversight of all audit professionals. Act as the liaison between the regulatory examiners and CareFirst operational areas. Initiate or maintain schedule for projects and project milestones. Track deliverables to facilitate timely completion of external audits.
- Develops and maintains strong collaborative working relationships with peers, Senior Management and their direct reports, personnel in subsidiaries and external auditors. Assist company operational teams and company management in addressing and resolving issues arising from external audits. Make recommendations for appropriate actions and follow-up reviews related to audit findings to ensure that the Company has successfully and consistently implemented corrective actions and performance tracking.
- Review audit rights, performance guarantees and other clauses that affect audit performance standards and perform thought leadership on impact on CareFirst. Understand the business environment and relate extensive knowledge of internal and external activities to trends identified within external audits. Act as a consultant for projects or work groups through utilizing the ability to begin with a concept and develop or act upon it. Assists with special projects as requested.
- Concurrently oversee, coordinate and schedule external audits or examinations to be conducted by auditors representing auditors representing CareFirst Groups. Act as the liaison between the external auditors and CareFirst operational areas. Initiate or maintain schedule for projects and project milestones. Track deliverables to facilitate timely completion of external audits.
QUALIFICATIONS:
Education Level: Bachelor’s Degree
Experience: 8 years of relevant experience, or equivalent relevant progressive work experience in health care administration, claims, customer service, health policy or a related field.
Knowledge, Skills and Abilities (KSAs)
- Proficient in quality audit processes and reporting requirements.
- Strong PC skills (Microsoft Outlook, Word, Excel, PowerPoint).
- Extensive analytical and problem solving skillsExtensive analytical and problem solving skills.
- Demonstrated skills conducting problem-solving discussions to negotiate effective solutions to audit issues.
- Knowledge of all claims, service and enrollment processing systems.
- Excellent communication skills (verbal and written) with the ability to influence and effectively communicate with all levels of associates and management.
- Advanced working knowledge of mainframe programs.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $84,960 – $168,740
Salary Range Disclaimer
Salary will be based on education, location, experience, certifications, etc. In addition to your salary, CareFirst offers benefits such as a comprehensive benefits package, incentive and recognition programs, and 401k contribution (all benefits are subject to eligibility requirements).
Department
Department: Compliance Performance Office
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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