CareFirst Careers

External Audit Account Representative

Resp & Qualifications

Purpose:
This position manages the myriad of activities associated with regulatory market conduct investigations, surveys, inquiries and examinations and large group audits to optimize audit performance and outcomes. The incumbent partners with and supports all levels of associates within CareFirst corporate functions and strategic business units throughout all phases of the external audit process including clarifying requirements, providing internal guidance regarding suitable responses, drafting CareFirst responses to audit inquiries or findings and coordinating the preparation and implementation of corrective action plans and the reporting of CareFirst progress against the plans.

PRINCIPAL ACCOUNTABILITIES:  Under the direction of the Sr. Director, External Audit Coordination & Privacy, the principle duties and responsibilities include, but are not limited to, the following:

Responsibilities:
Regulatory Matters
1. Independently manage assigned regulatory matters throughout the matter’s life cycle by evaluating the initial request and issues, seeking legal or other guidance, counseling associates towards a thorough response and representing CareFirst during ongoing interactions with the regulatory agency until the matter concludes.
2. Constructively and sensitively provide coaching and feedback to CareFirst associates regarding examiner expectations, requirements and responses. 
3. Assist the Senior Director in coordinating the document production required by regulatory agencies through serving as a key liaison between EAC and CareFirst associates.

Audit Management
1. Follow new business accounts beginning with the evaluation and response at the request for proposal stage, through the pre-implementation audit and the actual initial benefit audit.
2. Constructively and sensitively provide coaching and feedback to CareFirst associates regarding auditor expectations, requirements and responses.  Independently develops and offer viable options to resolve issues.
3. Develop and help manage the policies, procedures and tools used by External Audit Coordination to equip business owners and External Audit Coordination team to effectively respond to audits.    
4. Collaborate with other EAC analysts to track and report the status of open items or corrective action plans.

General
1. Track External Audit Coordination’s (EAC) progress against key performance indicators (KPIs). 
2. Prepare reports to be presented to and used by executive leadership and the Audit and Compliance Committee.
3. Garner the necessary data and other resources to respond to regulatory market conduct investigations, surveys, inquiries and examinations, large group audits and all associated findings.   Counsel and support associates at all levels of the enterprise as they evaluate requirements and prepare responses.
4. Provide final quality assurance reviews of certain analyses performed by junior-level EAC Analysts before documentation is released to any external party.
5. To minimize the risks to the Company, identify potential problem issues, share such observations with the appropriate CareFirst colleagues and actively participate in the resolution or action plan associated with the issues.  
6. Work closely and independently with insurance regulators, audit firm representatives and clients to facilitate assessment of the company’s compliance with jurisdictional regulations and contractual obligations. 
7. Independently represents CareFirst’s interests and the External Audit Coordination unit during meetings with internal and external customers regarding every aspect of the external audit process. Demonstrate the ability to assess and respond to questions, concerns in real time. 

QUALIFICATION REQUIREMENTS:
Education and Experience: 

  • Bachelor’s degree, preferably in Health Care Administration, Health Policy or Business Administration, or equivalent experience. 
  • 5+ years of audit experience in operational compliance or licensure audits, with 3 of those years in health care administration, claims, customer service, health policy or a related field.

Skills and Abilities

  • Must have excellent analytical and problem-solving skills, strong interpersonal skills, and strong computer skills including Excel. 
  • Must be able to problem solve such that various options are generated and evaluated. 
  • Ability to clearly and concisely communicate the pros and cons of proposed positions and options.
  • Must display leadership qualities, functional expertise, and business perspective.
  • Must possess solid oral and proven written communication and presentation skills.
  • Demonstrated experience working independently with regulatory agencies with minimum supervision and with direct interactions with high-level representatives of customers.
  • Ability to lead fluid conversation about carrier operations and to produce fruitful questioning and education of others.
  • Demonstrated experience and ability to work effectively with all level of associates within various operational departments across the organization.
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 
  • Must be able to produce accurate quality output within the established deadline and handle multiple customer service demands from internal and external customers within established expectations of service excellence.
  • Must be able and committed to effectively communicating and providing customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.  

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

Closing Date

Please apply before: 3/24/2019

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

Learn more about Audit & Legal