Sr. External Audit Specialist

Capital Blue Cross•Harrisburg, PA

About The Position

This position serves as a subject matter expert and liaison between Capital Blue Cross 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. The position plans and leads external audits, examinations, and surveys, including group benefit examinations, other group audits allowed by contract, BCBSA audits, and contractual compliance reviews. It coordinates audit schedules and resources, documentation collection, stakeholder responses, audit-item follow-up, corrective actions, and management reporting. The role also provides training and process guidance, recommends policies and procedures, supports contractual audit-rights reviews, and maintains collaborative relationships with auditors and internal teams.

Requirements

At least 5 years of experience in compliance or audit.
Project management experience.
Bachelor’s degree in accounting, finance, business, or data analytics, or at least 8 years of project management and/or audit experience in lieu of a degree.
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.
Strong organizational and project management skills, including experience planning, organizing, and managing complex cases or initiatives.
Ability to communicate complex issues clearly and concisely in writing and orally across organizational levels, with external auditors, and with account representatives.
Ability to establish and maintain cooperative, professional working relationships across multiple departments.
Ability to adapt to changing priorities and manage time effectively to meet urgent deadlines.
Knowledge of Capital commercial, ancillary, and government product lines and supporting operations and associated business ventures.
Working knowledge of sales, marketing, enrollment, billing, underwriting, configuration, IT, claims, customer service, clinical management, government programs, internal audit, and finance departments and administrative procedures; health insurance industry experience is preferred.
Familiarity with operational processing systems such as MARIS, Salesforce, and FACETS.

Nice To Haves

Experience in health care administration, claims processing, or pharmacy operations.
Advanced degree.
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) certification.

Responsibilities

Plan, organize, and lead external audit projects related to group benefit examinations, other contract-permitted group audits, BCBSA audits, and contractual compliance reviews.
Serve as the primary liaison between external auditors and Capital operational areas throughout 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 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 audit-related internal meetings, including meetings with senior leadership.
Provide guidance about Capital processes and organizational structure to internal and external stakeholders.
Oversee, coordinate, and schedule external audits, examinations, and surveys, balancing the audit schedule with available resources.
Collect and maintain requested documentation in compliance with Capital standards and ensure timely, 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.