Sr. Audit Specialist

Blue Cross Blue Shield of Massachusetts•Hingham, MA

3d•$89,460 - $109,340•Hybrid

About The Position

Reporting to the Director of Regulatory and PBM Audit, the Senior Auditor is a key member of the team responsible for the facilitation of regulatory, compliance, and Pharmacy Benefit Manager (PBM) audits. This role is critical in providing assurance to senior leadership and the Board of Directors that BCBSMA’s processes and controls are effective and in compliance with all government regulations and corporate policies. This is a high-profile position that offers significant exposure across the company, including interaction with regulators (e.g., DOI, CMS) and auditors from the Blue Cross Blue Shield Association (BCBSA). The ideal candidate is a highly organized and motivated professional with strong analytical and communication skills and a foundational understanding of BCBSMA’s business. This role is eligible for our Flex persona.

Requirements

Must demonstrate the highest level of integrity to establish and build trust with internal and external stakeholders.
Exceptional organizational, time management, and analytical skills with a keen attention to detail and the ability to manage multiple competing priorities effectively.
Excellent written and verbal communication skills, with the ability to build relationships, influence others, and clearly articulate complex issues to a variety of audiences.
Strong problem-solving aptitude with the ability to perform root-cause analysis and recommend practical solutions.
General business acumen and a strong desire to learn the intricacies of BCBSMA’s regulated products (e.g., MAPD, FEP), business operations, and our PBM relationship.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) is required.
An understanding of audit, risk management, or compliance principles is a plus.
Willingness to learn is essential.
Bachelor’s degree
3+ years of experience, preferably in a healthcare or health insurance environment.
High school degree or equivalent required unless otherwise noted above

Nice To Haves

Experience with or an understanding of BCBSMA’s regulated products or business operations is highly desirable.

Responsibilities

Conduct, support, or facilitate regulatory and PBM audits in compliance with established policies, plans, and procedures.
Identify gaps and opportunities for improving the efficiency and effectiveness of the end-to-end regulatory audit program.
Work cross-functionally with other Internal Audit teams (including Financial, Operational, and IT Audit), Corporate Compliance, and Fraud, Waste, and Abuse (FWA) teams to leverage existing work and address risks.
Manage audit inquiries, findings, and corrective action plans by working with business leaders across the organization.
Validate and provide assurance to stakeholders that appropriate root cause analysis has been completed and that corrective actions are effectively implemented.
Support multiple, concurrent projects, often with tight deadlines, reporting to different project leaders.
Maintain well-documented and organized work papers to support the team’s reporting responsibilities to executive leadership and the Audit Committee of the Board of Directors.