External Audit Lead

As an External Audit Lead you will perform complex postpayment preaudits of Wellmarks claims enrollment pharmacy etc. transactions in preparation for external audits conducted by our selffunded group clients government and regulatory agencies and the BCBSA including OIG/OPM. You will manage and coordinate audit documents to be provided to support Wellmarks business operations consult and provide documentation and results to auditors and government/regulatory agencies on potential issues and formulate Wellmarks response in collaboration with the appropriate business units.

Qualifications :

Required:

• Bachelors Degree in Accounting or related field
• Minimum 4 years of Auditing Finance Compliance or similar business experience within the health insurance or related industry
• Competent analytical skills with the ability to analyze data and make recommendations
• Strong attention to detail with the ability to complete tasks accurately keeping business regulations and rules in mind; proven ability to manage multiple priorities and projects simultaneously
• Practiced communication skills both verbal and written
• Ability to be flexible and adaptable while recommending changes to workflow to improve processes while guiding others through it
•  Practiced understanding of how business risk affects business strategy
• Demonstrated interpersonal skills with the ability to build maintain and leverage business relationships and consultation skills to drive results
• Ability to think critically using strong business knowledge and perspective to synthesize complex information
• Coach and mentor others by providing guidance and feedback to help strengthen their knowledge and skills
• Travel required up to 5

Preferred:

• Public accounting experience
• Prior auditing experience
• CIA CPA or similar certification or willingness to work towards certification

Additional Information :

1. Perform complex audits using statistical sampling audit methodologies; including coverage of core business transactions such as claims enrollment pharmacy benefit design and system coding and edits. Serves as the technical subject matter expert and Wellmark liaison for all external audits conducted on behalf of our selffunded group clients government and regulatory agencies and the BCBSA including OIG/OPM. Coordinate and manage document preparations and preaudit analysis research and development of audit responses and negotiation for final audit reporting to group customer.
2. Lead the audit process and meetings with auditors and examiners as the Wellmark representative and expert.
3. Responsible for discussing and negotiating audit issues with all levels of management or applicable stakeholders. Participate in exit conferences as appropriate and perform necessary followup to ensure issues are resolved effectively.
4. Coordinate and manage multiple audit projects; including issue identification and coordination of corrective action plans in accordance with regulatory requirements and federal guidelines (i.e. OPM OIG HHS CMS DOL BCBSA).
5. Prepare reports summarizing audit findings in an effective and organized manner consistent with established department standards and presents results to operational stakeholders. Collaborate and consult with business unit leaders to develop and monitor corrective action plans for any identified audit issue.
6. Compile and maintain audit documentation to support audit work performed conclusions/issues identified and recommendations/action plans. Develops desk level audit procedures as necessary for assigned audits.
7. Responsible for mentoring and coaching performance auditing staff by providing quality assurance feedback and subject matter expertise.  Assist leadership with development and of the quality assurance process.
8. Serve as corporate resource to other department or divisions by performing special projects including high dollar stoploss payment exception reviews at the request of department leadership.
9. Abide by the Standards for the Professional Practice of Internal Auditing and the Code of Ethics.
10. Other duties as assigned.

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