Audit Specialist

Blue Cross and Blue Shield of North Carolina

1d•Hybrid

About The Position

The Audit Specialist serves as the audit coordinator/representative for broader department audits, determining information needs and coordinating the information gathering process. They identify errors, determine root causes, and formulate recommendations for quality and process improvements. Additionally, they perform quality audits/reviews of departmental operations to assess the effectiveness of the customer experience against established policies and guidelines. The role involves providing feedback and coaching to operations staff and leadership to enhance performance and ensure understanding of processes. They also support the implementation of necessary remediation strategies. Operational functions audited can include claims processing, customer service call quality, membership processing, or sales/financial processes. Audits may serve various purposes, such as peer reviews, high dollar claim processing, improving customer interaction effectiveness, and individual/departmental performance improvement.

Requirements

High school diploma or GED
3+ years of experience in related field.

Nice To Haves

Experience supporting sales or customer-facing teams through quality assurance, audit, or enablement initiatives.
Familiarity with healthcare operations, regulations, or compliance environments.
Strong coaching and facilitation skills with the ability to translate audit insights into practical performance improvements.

Responsibilities

Design and implement targeted improvement interventions to close skill gaps, validating and sustaining measurable performance improvements.
Analyze operational quality reviews and audit findings to identify error trends, root causes, and compliance or operational risks; communicate insights to leadership.
Partner with leaders to conduct skill gap analyses and define development goals aligned to business and sales performance needs.
Coordinate and perform complex departmental and regulatory audits (government-required audits), including self-testing and risk/control assessments.
Build trust-based coaching relationships that foster a safe learning environment and support effective knowledge transfer across teams.
Develop and deliver in-depth training and “deep dive” learning sessions for frontline staff and leaders focused on specific call types or transactions, compliance or audit-driven risk areas, and system, process, or technology changes, or recurring quality or documentation errors.
Create and maintain a centralized knowledge repository by compiling best practices from experience, audits, and research.
Develop transition and learning action plans to support continuous performance improvement and standardized process adoption.
Document business process, policy, and procedural changes and translate updates into training materials, workflows, job aids, narratives, and reference guides to support consistency, compliance, and continuous learning.
Provide clear, actionable coaching and feedback—written and verbal—at the individual and team level to improve quality outcomes.
Partner with Internal Audit and support external auditors; conduct periodic quality reviews of Quality Auditors’ work and share results with management.
Serve as a department subject matter expert and project representative, supporting issue resolution, audit exceptions, training needs, and supplemental leadership coverage when needed.