- Plan, organize and manage external audit projects of varying complexity and length. Concurrently oversee, coordinate and schedule multiple external audits or examinations to be conducted by auditors representing CareFirst groups or regulatory examiners. 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.
- Define problems, collect and review data, establish facts, draw valid conclusions and make thoughtful recommendations. Use analytical and problem resolution skills and apply Continuous Quality Improvement principles to system, departmental, data and other relevant issues impacting audit and reporting requirements or performance.
- Communicate in clear and concise manner, prepare cohesive and comprehensive written memos, emails and audit report responses documenting observations and CareFirst position, scope, objectives, procedures, findings, recommendations, comparisons, impacts, risks and projections, often under strict timelines.
- 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 team leader for small projects or work groups through utilizing the ability to begin with a concept and develop or act upon it. May assist with special projects as requested.
- 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.
- Good 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.
Senior External Audit Analyst - Baltimore, United States - CareFirst BlueCross BlueShield
Description
PURPOSE:
The External Audit Analyst plans, organizes and manages CareFirst external audit activities (group customer audits, regulatory market conduct examinations, investigations, surveys and inquiries).ESSENTIAL FUNCTIONS:
QUALIFICATIONS:
Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years of audit experience, in operational or compliance audits, with 3 of those years in health care administration, claims, customer service, health policy or a related field.
Knowledge, Skills and Abilities (KSAs)
Department
Department:
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.