[Hiring] Senior External Audit Specialist @Capital Blue Cross

Role Description

This position serves as a subject matter expert and liaison between Capital Blue Cross (Capital) internal business units, external auditors, and regulatory agencies. This role ensures successful execution of external audits, response oversight, and compliance with Capital processes and standards. The position requires deep knowledge of Capital 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.

• Plan, organize, and lead external audit projects related to group benefit examinations and other group audits allowed by the contract, BCBSA audits, and contractual compliance reviews.
• Act as primary liaison between external auditors and Capital operational areas on all aspects of external audits.
• Track and manage audit deliverables, ensuring timely completion and accurate documentation.
• Provide training to internal parties for appropriate support in engaging with external auditors and reviewing noted audit exceptions.
• Recommend and develop department policy and procedures.
• Provide leadership to ensure Capital meets its contractual obligations with respect to existing group audit rights and compliance clauses.
• Review and 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 Capital standards.
• Lead internal meetings, including Senior Leadership, to discuss audit-related matters.
• Demonstrate knowledge of Capital processing systems, including Pharmacy (Rx) workflows.
• Provide guidance on Capital processes and organizational structure to internal and external stakeholders.
• Oversee, coordinate, and schedule external audits, examinations, or surveys.
• 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 Capital leadership, providing updates on audit progress and compliance risks.
• Prepare and present reports for management review.

Qualifications

• Deep understanding of Capital systems and processes.
• Strong negotiation skills.
• Proficient in Microsoft Office Suite and audit tracking tools, combined with analytical and problem-solving skills.
• Exceptional organizational and project management skills.
• Ability to influence and communicate effectively through written and oral communications across all levels of the organization.
• Ability to establish and maintain cooperative and professional working relationships across multiple departments within Capital.
• Ability to adjust to changing priorities and manage time effectively to meet urgent deadlines.

Requirements

• 5 years' experience in compliance/audit.
• Project management experience required.
• Experience in health care administration, claims processing, pharmacy operations preferred.

Education and 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).

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• Incentive Plan.
• Tuition Reimbursement.