Sr. External Audit Specialist

Capital Blue Cross•Harrisburg, PA

2d•$75,400 - $140,020

About The Position

This position serves as a subject matter expert and liaison between Capital Blue Cross (Capital) internal business units, external auditors, and regulatory agencies. It ensures successful execution of external audits, oversight of responses, and compliance with Capital processes and standards. The role requires deep knowledge of Capital’s organizational structure, claims processing systems, and operational workflows. The incumbent independently manages complex projects, interacts with senior leadership, and remains accountable for audit deliverables and reporting.

Requirements

At least 5 years of experience in compliance or audit.
Project management experience.
A 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.
Deep understanding of Capital systems and processes.
Strong negotiation skills.
Proficiency in Microsoft Office Suite and audit tracking tools, with analytical and problem-solving skills.
Exceptional organizational and project management skills, including experience planning, organizing, and managing complex cases or initiatives.
Ability to communicate effectively in writing and orally across organizational levels and with external auditors and account representatives, including explaining complex issues concisely and in an organized manner.
Ability to establish and maintain cooperative, professional working relationships across multiple Capital departments.
Ability to adjust to changing priorities and manage time effectively to meet urgent deadlines.
Knowledge of Capital commercial, ancillary, and government product lines and the operations supporting products sold or serviced by Capital and its associated business ventures.
Working knowledge of departments and administrative procedures in sales, marketing, enrollment, billing, underwriting, configuration, IT, claims, customer service, clinical management, government programs, internal audit, and finance processes.

Nice To Haves

Experience in health care administration, claims processing, or pharmacy operations.
Knowledge of the health insurance industry.
Familiarity with operational processing systems such as MARIS, Salesforce, and FACETS.
An advanced degree.
Certifications such as Certified Quality Auditor (CQA), Certified Internal Auditor (CIA), Certified Information Systems Auditor (CISA), Certified Public Accountant (CPA), Certified Risk Management Assurance (CRMA), or Certified Analytics Professional (CAP).

Responsibilities

Plan, organize, and lead external audit projects related to group benefit examinations, other group audits allowed by contract, BCBSA audits, and contractual compliance reviews.
Serve as the 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.
Train internal parties to support engagement with external auditors and review noted audit exceptions.
Recommend and develop department policies and procedures.
Provide leadership to ensure Capital meets contractual obligations related to existing group audit rights and compliance clauses.
Review proposed changes to contractual audit rights with Legal and advise Sales and Underwriting Management on prospective changes.
Maintain collaborative relationships with external auditors and ensure adherence to Capital standards.
Lead internal meetings, including Senior Leadership meetings, to discuss audit-related matters.
Provide guidance on Capital processing systems, including Pharmacy (Rx) workflows, processes, and organizational structure to internal and external stakeholders.
Oversee, coordinate, and schedule external audits, examinations, or surveys; maintain an audit schedule balanced with available resources; collect and maintain requested documentation in compliance with Capital standards; and support timely audit completion and professional responses from internal stakeholders.
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 audit progress and compliance risks to Capital leadership.
Prepare and present reports for management review.