Senior Auditor (Regulatory)

Blue Cross and Blue Shield Association

Philadelphia, PA

JOB DETAILS
SKILLS
Accounting Audit Software, Accounting Software, Auditing, Business Administration, Certified Public Accountant (CPA), Communication Skills, Content Management Systems (CMS), Corporate Compliance, Corrective Action, Data Analysis, Detail Oriented, ERISA (Employee Retirement Income Security Act of 1974), Federal Laws and Regulations, Financial Audit, Financial Operations, Healthcare, Insurance, Leadership, Medical Billing, Medicare, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, Multitasking, Operational Audit, Organizational Skills, Presentation/Verbal Skills, Public Accounting, Regulations, Regulatory Compliance, Regulatory Requirements, Reporting Skills, Risk, Risk Management, SQL Databases, State Laws and Regulations, Statistical Sampling, Tableau, Team Player, Testing, Writing Skills
LOCATION
Philadelphia, PA
POSTED
18 days ago

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.

The ideal candidate for the Senior Regulatory Auditor position will be an excellent communicator (written and verbal) who is detail-oriented and organized. He/she will also be able to work independently and with a team, demonstrating self-motivation and enthusiasm. The Senior Regulatory Auditor will be performing risk-based audits concerning the operation and regulatory compliance of the Company.

Responsibilities:

  • Plan, coordinate, and lead key financial, operational, and regulatory audits of the Company and its subsidiaries.
  • Develop audit programs by working with the Company and department Management.
  • Document processes and controls by utilizing flowcharts and/or narratives.
  • Perform substantive and control testing.
  • Make recommendations and develop corrective action plans based on testing results and partner with impacted business areas on remediation efforts.
  • Develop draft audit reports for audits and special projects. Assist in preparing the final versions of audit reports.
  • Perform follow-up on the status of recommendations made in previous audit reports.
  • Review and determine how federal and state regulatory requirements impact the Company and assist in the evaluation of the Company's compliance with such requirements, including but not limited to, the Affordable Care Act and Medicare.
  • Assist in the coordination of reviews completed by external regulatory bodies as needed (i.e., market conduct exams).
  • Communicate effectively with all levels of management.
  • Utilize data analytics during the planning and execution of planned audits to help achieve more comprehensive coverage of risk mitigation.
  • Perform ad hoc projects as applicable.

Qualifications:

  • Bachelor's degree in accounting, business, healthcare, or equivalent work experience
  • Three-plus years of audit experience in a large public accounting firm or healthcare setting preferred
  • Previous experience leading or performing audits independently
  • Knowledge of commercial, Medicare Advantage, and/or self-funded insurance plans and third-party administrator operations and regulations (e.g., ACA/CMS/ERISA/DOL) preferred
  • Knowledge of auditing, accounting systems, flowcharting, and statistical sampling techniques

Additional Skills/Experience:

  • Previous insurance or healthcare audit experience preferred
  • Strong oral and written communication skills
  • Strong attention to detail with the ability to work on multiple projects simultaneously
  • Ability to work independently and as part of a team
  • CPA, CIA, or JD certification preferred
  • Advanced degree (MBA, MHA, etc.) is a plus
  • Proficient to advanced skillset working in and knowledge of Microsoft Office tools (i.e., MS Excel, MS Word, MS PowerPoint, Copilot) preferred
  • Previous experience with ACL or other audit software a plus
  • Tableau, SQL, or database knowledge a plus

Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

About the Company

B

Blue Cross and Blue Shield Association

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.
COMPANY SIZE
2,000 to 2,499 employees
INDUSTRY
Insurance
WEBSITE
https://www.bcbs.com/about-us/careers