Sr. External Audit Specialist

Overview

This position serves as a subject matter expert and liaison between the organization’s internal business units, external auditors, and regulatory agencies. The role ensures successful execution of external audits, provides oversight of audit responses, and supports compliance with organizational processes and standards. Responsibilities include independently managing complex projects, interacting with senior leadership, and maintaining accountability for audit deliverables and reporting.

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 relevant 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 engaging external auditors and reviewing noted audit exceptions.
• Recommend and develop departmental policy and procedures.
• Lead efforts to ensure the organization meets contractual obligations related to existing group audit rights and compliance clauses.
• Review proposed changes to contractual audit rights with Legal, and advise Sales and Underwriting Management on prospective changes.
• Maintain strong, collaborative relationships with external auditors and ensure adherence to organizational standards.
• Lead internal meetings (including with senior leadership) to discuss audit-related matters.
• Demonstrate knowledge of processing systems, including Pharmacy (Rx) workflows.
• Provide guidance to internal and external stakeholders on organizational processes and structure.
• Oversee, coordinate, and schedule external audits, examinations, or surveys, including:
  • Maintaining an external audit schedule balanced with existing resources
  • Collecting and maintaining all requested documentation in compliance with organizational standards
  • Ensuring timely completion of external audits
  • 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

• 5 years’ experience in compliance/audit.
• Project management experience required.
• Experience in health care administration and claims processing; experience in pharmacy operations preferred.
• Deep understanding of organizational 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 planning and managing complex initiatives.
• Ability to influence and communicate effectively (written and oral) across all organizational levels and with external auditors/account representatives, with a focus on conveying complex issues clearly and concisely.
• Ability to establish and maintain cooperative, professional 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 related business ventures.
• 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 operational processing systems used across business operations, including MARIS, Salesforce, and FACETS.

Education & Certifications

• 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).

Compensation & Benefits

• Base pay is influenced by qualifications, relevant experience, and anticipated contributions to meet business needs, along with internal pay equity and external market-driven rates.
• The salary range shown has not been adjusted for geographical location and may be modified in the future.
• 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 posting.

Equal Opportunity Employer

• The organization is an equal opportunity employer and does not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.