External Audit Lead

Company Description

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Want to know more? You can learn about life at Wellmark here.

Job Description

As an External Audit Lead you will perform complex post-payment pre-audits of Wellmark’s claims, enrollment, pharmacy, etc. transactions in preparation for external audits conducted by our self-funded group clients, government and regulatory agencies, and the BCBSA, including OIG/OPM. You will manage and coordinate audit documents to be provided to support Wellmark’s business operations, consult and provide documentation and results to auditors and government/regulatory agencies on potential issues, and formulate Wellmark’s response in collaboration with the appropriate business units.

Qualifications

Required:

• Bachelor’s Degree in Accounting or related field
• Minimum 4 years of Auditing, Finance, Compliance or similar business experience within the health insurance or related industry
• Competent analytical skills, with the ability to analyze data and make recommendations
• Strong attention to detail with the ability to complete tasks accurately keeping business regulations and rules in mind; proven ability to manage multiple priorities and projects simultaneously
• Practiced communication skills, both verbal and written
• Ability to be flexible and adaptable while recommending changes to workflow to improve processes while guiding others through it
•  Practiced understanding of how business risk affects business strategy
• Demonstrated interpersonal skills with the ability to build, maintain and leverage business relationships and consultation skills to drive results
• Ability to think critically using strong business knowledge and perspective to synthesize complex information
• Coach and mentor others by providing guidance and feedback to help strengthen their knowledge and skills
• Travel required up to 5%

Preferred:

• Public accounting experience
• Prior auditing experience
• CIA, CPA or similar certification, or willingness to work towards certification

Additional Information

1. Perform complex audits using statistical sampling audit methodologies; including coverage of core business transactions such as claims, enrollment, pharmacy, benefit design, and system coding and edits. Serves as the technical subject matter expert and Wellmark liaison for all external audits conducted on behalf of our self-funded group clients, government and regulatory agencies, and the BCBSA, including OIG/OPM. Coordinate and manage document preparations and pre-audit, analysis, research and development of audit responses, and negotiation for final audit reporting to group customer.
2. Lead the audit process and meetings with auditors and examiners, as the Wellmark representative and expert.
3. Responsible for discussing and negotiating audit issues with all levels of management or applicable stakeholders. Participate in exit conferences as appropriate and perform necessary follow-up to ensure issues are resolved effectively.
4. Coordinate and manage multiple audit projects; including issue identification and coordination of corrective action plans in accordance with regulatory requirements and federal guidelines (i.e., OPM, OIG, HHS, CMS, DOL, BCBSA).
5. Prepare reports summarizing audit findings in an effective and organized manner consistent with established department standards and presents results to operational stakeholders. Collaborate and consult with business unit leaders to develop and monitor corrective action plans for any identified audit issue.
6. Compile and maintain audit documentation to support audit work performed, conclusions/issues identified and recommendations/action plans. Develops desk level audit procedures, as necessary, for assigned audits.
7. Responsible for mentoring and coaching performance auditing staff by providing quality assurance feedback and subject matter expertise.  Assist leadership with development and execution of the quality assurance process.
8. Serve as corporate resource to other department or divisions by performing special projects, including high dollar stop-loss payment exception reviews, at the request of department leadership.
9. Abide by the Standards for the Professional Practice of Internal Auditing and the Code of Ethics.
10. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

Please inform us if you meet the definition of a "Covered DoD official".