Senior External Audit Analyst (Hybrid)

CareFirst•Baltimore, MD

3d•Hybrid

About The Position

The External Audit Analyst plans, organizes and manages CareFirst external audit activities (group customer audits, regulatory market conduct examinations, investigations, surveys and inquiries). This role involves planning, organizing, and managing external audit projects of varying complexity and length. The analyst will concurrently oversee, coordinate, and schedule multiple external audits or examinations conducted by auditors representing CareFirst groups or regulatory examiners. They will act as the liaison between external auditors and CareFirst operational areas, initiate or maintain schedules for projects and milestones, and track deliverables for timely completion. The role requires defining problems, collecting and reviewing data, establishing facts, drawing valid conclusions, and making thoughtful recommendations. Utilizing analytical and problem-resolution skills, the analyst will apply Continuous Quality Improvement principles to systems, departments, data, and other relevant issues impacting audit and reporting requirements or performance. Communication is key, involving clear and concise preparation of written memos, emails, and audit report responses documenting observations and CareFirst's position, scope, objectives, procedures, findings, recommendations, comparisons, impacts, risks, and projections, often under strict timelines. The analyst will assist company operational teams and management in addressing and resolving issues arising from external audits, making recommendations for appropriate actions and follow-up reviews to ensure corrective actions are successfully and consistently implemented. Additionally, they will review audit rights, performance guarantees, and other clauses affecting audit performance standards, providing thought leadership on their impact on CareFirst. Understanding the business environment and relating extensive knowledge of internal and external activities to trends identified within external audits is crucial. The role may involve acting as a team leader for small projects or work groups and assisting with special projects as requested.

Requirements

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.
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.
Proficient in quality audit processes and reporting requirements.
Strong PC skills (Microsoft Outlook, Word, Excel, PowerPoint).
Extensive 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 eligible to work in the U.S. without Sponsorship.

Responsibilities

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.