Senior External Audit Specialist
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Job Description
External audit specialist leading group benefit, BCBSA, and contractual compliance audits for Capital Blue Cross health insurance operations. Coordinating auditors, documentation, corrective actions, and executive reporting.
Responsibilities:
- Plan, organize, and lead external audit projects related to group benefit examinations, group audits, BCBSA audits, and contractual compliance reviews
- Act as primary liaison between external auditors and Capital operational areas
- Track and manage audit deliverables, ensuring timely completion and accurate documentation
- Provide training to internal parties supporting external auditors and reviewing audit exceptions
- Recommend and develop department policies and procedures
- Ensure Capital meets contractual obligations related to group audit rights and compliance clauses
- Review proposed changes to contractual audit rights with Legal and advise Sales and Underwriting Management
- Maintain collaborative relationships with external auditors and ensure adherence to Capital standards
- Lead audit-related meetings, including with senior leadership
- Provide guidance on Capital processes and organizational structure
- Oversee, coordinate, and schedule external audits, examinations, and surveys
- Maintain an external audit schedule, collect requested documentation, and ensure timely, professional responses
- Monitor audit items, assign tasks, and ensure timely follow-up
- Recommend corrective actions and verify implementation through performance tracking
- Communicate audit progress and compliance risks to Capital leadership
- Prepare and present reports for management review
Requirements:
- 5 years' experience in compliance/audit
- Project management experience required
- Bachelor’s degree in accounting, finance, business, or data analytics, or the equivalent of 8 or more years in project management and/or audit experience required
- Advanced degree preferred
- Certifications preferred: Certified Quality Auditor (CQA), Certified Internal Auditor (CIA), Certified Information Systems Auditor (CISA), Certified Public Accountant (CPA), Certified Risk Management Assurance (CRMA), Certified Analytics Professional (CAP)
- Deep understanding of Capital systems and processes
- Strong negotiation skills
- Proficiency in Microsoft Office Suite and audit tracking tools
- Analytical and problem-solving skills
- Exceptional organizational and project management skills
- Knowledge of Capital commercial, ancillary, and government product lines and supporting operations
- Working knowledge of sales, marketing, enrollment, billing, underwriting, configuration, IT, claims, customer service, clinical management, government programs, internal audit, and finance processes, preferably in the health insurance industry
- Familiarity with MARIS, Salesforce, and FACETS
- Ability to communicate effectively across all organizational levels
- Ability to establish and maintain cooperative professional relationships
- Ability to adjust to changing priorities and meet urgent deadlines
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Flexible environment
- Training and continuing education
- Community volunteering opportunities
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