CareFirst Careers

Director, External Audit

Resp & Qualifications

PURPOSE:
The Director, External Audit leads, directs and oversees the activities of Group, Regulatory, Performance, Operational Audits, and External Audit Coordination.

ESSENTIAL FUNCTIONS:

  • Directs and oversees all external audits conducted by customers and regulators, including the Maryland Insurance Administration (MIA), Virginia Bureau of Insurance (VBOI), DC Department of Insurance, Securities & Banking (DISB), Office of Personnel Management, CMS, Department of Labor, the BlueCross BlueShield Association and identified Federal and State agencies including those charged with review of Health Care Reform implementation. Works extensively with the insurance regulators regarding target market conduct examinations and other inquiries dealing with the company’s compliance with jurisdictional regulations. Minimizes risk to the company by responding to or performing specific audits to determine compliance, and if necessary, ensuring appropriate actions are taken to put the company in compliance. Ensures risks to the company are minimized during audits by directing and overseeing comprehensive analysis of data being requested by and submitted to the auditors. Coordinates and directs all responses and follow-up to audit findings and draft audit reports. Monitors follow-up action plans on audit findings and reports to management on a quarterly basis.

  • Develops and maintains strong collaborative working relationships with peers, Senior Management and their direct reports, personnel in subsidiaries and external auditors. Develops and maintains positive, productive, professional working relationships with regulators. Seeks opportunities to educate management and associates on the importance of risk mitigation, effective internal controls and compliance with applicable regulations. Gathers and prepares a quarterly report to Senior Management on Fines & Penalties for the Company. Responsible for managing all operational aspects of market conduct examinations, including validation and management of administrative penalties and expenses associated with the exams.

  • Supports Sales and Marketing team in their efforts to retain and acquire business through managing high risk and high-profile audits, communications and account service challenges.  To this end, establishes and maintains working relationships with customer representatives and consultants.    Provides cross functional consultative/advisory services to with business unit’s response to regulatory and audit related matters.

  • Other duties as assigned: to include but not limited to administrative support to manage the unit(s) by preparing, monitoring and analyzing the unit(s)’ budget, administering the annual CAD and incentive process for the unit(s), maintaining unit(s) staff and PCN controls, providing leadership and coaching to existing staff to expand skills and knowledge as individually required.


SUPERVISORY RESPONSIBILITY:
This position manages 1-5 people.

QUALIFICATIONS:

Education Level: 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.

Experience: 10 years in relative field, 10+ years relevant experience, or equivalent relevant progressive work experience in insurance or insurance related fields and 5 years of supervisory/management experience.

Preferred Qualifications:
Juris Doctorate or relevant advanced degree preferred
•  At least one professional insurance industry certification (i.e. Certified Compliance and Ethics Professional, HCP –Healthcare Compliance Professional)

Knowledge, Skills and Abilities (KSAs)

  • Extensive experience and or knowledge of the regulatory/insurance environment.
    • Working knowledge of legal / regulatory requirements for operation of a health plan.
  • Demonstrated leadership skills to include, but not limited to, strategic thinking, facilitating, negotiating, conflict management, coaching, problem solving and staff development.
  • Broad experiential and knowledge base of the insurance, regulatory and auditing industry.

Department

Department: External Audit Coordination

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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