Sr. External Audit Specialist

Overview

This position serves as a subject matter expert and liaison between internal business units, external auditors, and regulatory agencies. The role ensures successful execution of external audits, provides oversight in audit responses, and supports compliance with internal processes and standards. Success in this position requires deep knowledge of organizational structure, claims processing systems, and operational workflows. The incumbent will independently manage complex projects, interact with senior leadership, and maintain accountability for audit deliverables and reporting.

Base pay is influenced by qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range was created in good faith based on information known at the time of posting and may be modified in the future.

Responsibilities

• Plan, organize, and lead external audit projects related to group benefit examinations and other group audits allowed by contract, BCBSA audits, and contractual compliance reviews.
• Serve as the primary liaison between external auditors and internal operational areas for all aspects of external audits.
• Track and manage audit deliverables to ensure timely completion and accurate documentation.
• Provide training to internal parties on appropriate support for engaging with external auditors and reviewing noted audit exceptions.
• Recommend and develop department policy and procedures.
• Provide leadership to ensure contractual obligations are met regarding existing group audit rights and compliance clauses.
• Coordinate with Legal on proposed changes to contractual audit rights, and advise Sales and Underwriting Management on prospective changes.
• Maintain strong, collaborative relationships with external auditors and ensure adherence to internal standards.
• Lead internal meetings, including Senior Leadership, to discuss audit-related matters.
• Demonstrate knowledge of operational processing systems, including Pharmacy (Rx) workflows.
• Provide guidance on internal processes and organizational structure to internal and external stakeholders.
• Oversee, coordinate, and schedule external audits, examinations, or surveys, including maintaining an external audit schedule balanced with existing resources; collecting and maintaining requested documentation in compliance with internal standards; ensuring timely completion; and ensuring adequate, timely, professional responses from internal stakeholders.
• Monitor open and closed audit items, assign tasks, and ensure timely follow-up.
• Recommend corrective actions to operational functions and verify implementation through performance tracking.
• Communicate effectively with leadership, providing updates on audit progress and compliance risks.
• Prepare and present reports for management review.

Requirements

• Deep understanding of internal systems and processes.
• Strong negotiation skills.
• Proficiency in Microsoft Office Suite and audit tracking tools, with analytical and problem-solving skills.
• Exceptional organizational and project management skills, including experience planning, organizing, and managing complex cases or initiatives.
• Ability to influence and communicate effectively through written and oral communications across all levels of the organization, as well as with external auditors and account representatives, with an emphasis on communicating complex issues in an organized and concise manner.
• Ability to establish and maintain cooperative and professional working relationships across multiple departments.
• Ability to adjust to changing priorities and manage time effectively to meet urgent deadlines.
• Knowledge of commercial, ancillary, and government product lines and supporting operations sold/serviced by the organization and its associated business ventures.
• Working knowledge of departments and administrative procedures in 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 operational processing systems used across business operations, such as MARIS, Salesforce, and FACETS.
• 5 years’ experience in compliance/audit.
• Project management experience required.
• Experience in health care administration and claims processing required; pharmacy operations preferred.
• 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.

Preferred Qualifications

• Advanced degree.
• Certifications: 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).
• Experience in health care administration, claims processing, and pharmacy operations.

Compensation & Benefits

• Base pay influenced by qualifications, relevant experience, anticipated contributions, internal pay equity, and external market-driven rates. Salary range displayed has not been adjusted for geographical location.
• Comprehensive benefits package, including:
  • Medical, Dental & Vision coverage
  • Retirement Plan
  • Paid Time Off, Holidays, and Volunteer time off
  • Incentive Plan
  • Tuition Reimbursement
  • Additional benefits

Location

• Not specified in the provided description.