CareFirst Careers

Audit Risk and Compliance Manager

Resp & Qualifications

Purpose
The Integrated Compliance and Risk Department is responsible for the education, empowerment and strategic direction for Audit and Compliance atCareFirst. The Integrated Compliance and Risk- Audit Manager position is responsible for managing the Audit Functional Area within the CareFirst Integrated Risk and Compliance Department. Accountable for ensuring execution all audits performed by internal and external auditors, implementation of corrective action and assessing and monitoring the effectiveness of internal control and reports directly to the Director of Integrated Compliance and Risk.

Audit Program Management

  • Develops and manages approach to maturing the audit function into a comprehensive risk-based audit program designed to effectively test, continuously reviews an improves internal control and departmental procedures to achieve greater efficiencies and effectiveness.
  • Establishes a tools and processes for reviewing internal controls, both manual and automated, in each functional area and assessing operational effectives, risk mitigation and audit remediation.
  • Analyzes controls for strengths and weaknesses and ensures that special focus is allocated to the specific risk areas creating the highest exposure to the CareFirst.
  • Continuously analyzes and aligns all functional area Policies and Procedures, SOPs, workflows, and systems and ensure they are in compliance and alignment with regulations and remain updated and current
  • Reviews complex business processes, systems, workflows, SOPs to identify, document, and elevate the presence of risks and trends that may be non-compliant with Contract and or Corporate Policies
  •  Manage the execution of all audits performed by internal audit organization Corporate Audit and Assurance Services (CAAS) and external independent audits.  Ensuring the audit workflow from audit kick-off to audit close occurs as planned, appropriate stakeholders are involved, emerging issues are reported, and audit metrics are captured to ensure accurate status reporting

Monitoring and Reporting

  • Manages the activities related to reviewing audit findings with stakeholders and ensuring management responses address root cause
  • Actively participate in implementation/corrective workgroups to ensure audit perspective and concerns are addressed through the process.
  • Ensure plans are established for all findings and monitor corrective action plan as an outcome of any audit findings and monitors/communicates plan status and risks associated with control deficiencies identified to all stakeholders. 
  • Regular monitoring and control of corrective action plan implementation and communication of risk associated with the control deficiencies identified to all stakeholders.
  • Provide regular investigative, analytic and audit reporting data to all stakeholders.
  • Assists CareFirstmanagement in discharging their responsibilities by mitigating risks, safeguarding assets, identifying fraudulent activities, complying with laws and regulations directly tied to operational efficiency.
  • Monitors, assesses, and reports significant matters to senior management.
  • Keeps abreast of emerging issues and developments that have direct impact on CareFirst.

Relationship Management

  • Develops and maintains relationships with key internal customers (i.e.,CAAS auditors, Line of business  management, senior executives, etc.) and external customers( BCBSA and independent auditors) through visibility gained by direct meetings, participation on various corporate committees, actively participate on committees, project teams, and other cross-departmental initiatives.
  • Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with all members within regulatory departments. 
  • Maintain positive, responsive, respectful relationships with all stakeholders.
  • Set high expectations of significant influence on others across the enterprise for all audit activities, risk assessments and process improvements to support control objectives with cross-functional impacts. 
  • Drive commitment and continuous personal improvement, self-confidence, insight, judgment, integrity, ethics, and responsiveness, timeliness, flexibility and adaptability.
  • Serves as the subject matter expert for CareFirstAudit processes and related systems           
  • Set high expectations of significant influence on others across the enterprise for all audit activities, risk assessments and process improvements to support control objectives with cross-functional impacts. 
  • Drive commitment and continuous personal improvement, self-confidence, insight, judgment, integrity, ethics, and responsiveness, timeliness, flexibility and adaptability

Governance Risk and Compliance (GRC) Program

  • Provide support to ensure compliance with the established CareFirst Common Compliance Framework (CCF).
  • Support the development of enterprise reporting and dashboards for monitoring and analysis of process-level risks, controls, issues, risk management, and audit activities.
  • Support maintenance of the centralized repository for all audits including but not limited to accountable business owners, audit reports, corrective action documentation, etc
  • Facilitate due diligence on third party controls, in collaboration with subject matter resources across all relevant risk domains to determine residual risk of third-party relationships.

Qualification Requirements:
Required:


• Bachelor’s degree with 5+ years of work experience in Audit, Finance, Compliance, or related fields.
•2+ years of experience in staff management.  
 

Preferred: 

•Understanding of Healthcare Regulatory requirements and health insurance operations

•Relevant risk or business certification (e.g., CPA, CIA, CISA, CISM)

•Experience managing audits


Abilities/Skills:
• The ability to effectively manage staff through leadership and the promotion of teamwork is essential. 
• Ability to gather and analyze data and generate reports.
• Working knowledge and application of GAAP.

• Incumbent must display leadership qualities, functional expertise, and business perspective.
• Considerable judgment, tact, initiative, accuracy, trustworthiness, and integrity.
• Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.
• Ability to present and discuss audit management issues in a way that establishes rapport, persuades others, and gains commitment.
• Ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem.
• Demonstrated ability to lead problem-solving discussions.
• Must be able to effectively work in a fast-paced environment, be flexible, and possess the ability to adapt to shifting priorities, to work independently as well as part of a team. Strong customer service, organizational, coordination skills and interpersonal skills for facilitating and managing audits
• Experienced and proficient with Word, Advanced Excel and database management and related software applications
• Excellent oral and written communications; able to communicate and make presentation to all levels of management and associates at all levels throughout the Company
 

 

 

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: 12/9/2020

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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