Sr. Audit Specialist

Reporting to the Director of Regulatory and PBM Audit, the Senior Auditor is a key member of the team responsible for the facilitation of regulatory, compliance, and Pharmacy Benefit Manager (PBM) audits. This role is critical in providing assurance to senior leadership and the Board of Directors that BCBSMA’s processes and controls are effective and in compliance with all government regulations and corporate policies. This is a high-profile position that offers significant exposure across the company, including interaction with regulators (e.g., DOI, CMS) and auditors from the Blue Cross Blue Shield Association (BCBSA). The ideal candidate is a highly organized and motivated professional with strong analytical and communication skills and a foundational understanding of BCBSMA’s business.

This role is eligible for our Flex persona.

Key Responsibilities:

This is an individual contributor role that will ensure that audits are performed timely and efficiently by external auditors, vendors and regulators, and issues are corrected timely and appropriately. This role will also ensure evaluation and testing of certain internal controls are performed effectively and timely.

• Conduct, support, or facilitate regulatory and PBM audits in compliance with established policies, plans, and procedures.
• Identify gaps and opportunities for improving the efficiency and effectiveness of the end-to-end regulatory audit program.
• Work cross-functionally with other Internal Audit teams (including Financial, Operational, and IT Audit), Corporate Compliance, and Fraud, Waste, and Abuse (FWA) teams to leverage existing work and address risks.
• Manage audit inquiries, findings, and corrective action plans by working with business leaders across the organization.
• Validate and provide assurance to stakeholders that appropriate root cause analysis has been completed and that corrective actions are effectively implemented.
• Support multiple, concurrent projects, often with tight deadlines, reporting to different project leaders.
• Maintain well-documented and organized work papers to support the team’s reporting responsibilities to executive leadership and the Audit Committee of the Board of Directors.

Challenges/Problem Solving:

• Working independently and as part of a team on different projects
• Managing multiple projects with tight deadlines
• Working with different project leaders
• Ability to escalate issues or problems quickly

Decision Making Authority: 

• While this is an individual contributor role, the position will be responsible for ensuring audit vendors perform audits according to schedules and for escalating issues to BCBSMA timely.

Qualifications (knowledge/skills/abilities/behaviors):

• Integrity and Professionalism: Must demonstrate the highest level of integrity to establish and build trust with internal and external stakeholders.
• Organizational & Analytical Skills: Exceptional organizational, time management, and analytical skills with a keen attention to detail and the ability to manage multiple competing priorities effectively.
• Communication & Interpersonal Skills: Excellent written and verbal communication skills, with the ability to build relationships, influence others, and clearly articulate complex issues to a variety of audiences.
• Problem-Solving: Strong problem-solving aptitude with the ability to perform root-cause analysis and recommend practical solutions.
• Business Acumen: General business acumen and a strong desire to learn the intricacies of BCBSMA’s regulated products (e.g., MAPD, FEP), business operations, and our PBM relationship.
• Technical Skills: Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) is required.
• An understanding of audit, risk management, or compliance principles is a plus. Willingness to learn is essential.

Education/Relevant Experience: List in order of importance.

• Bachelor’s degree
• 3+ years of experience, preferably in a healthcare or health insurance environment.
• Experience with or an understanding of BCBSMA’s regulated products or business operations is highly desirable.

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note:  No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap and imposter syndrome can  prevent  amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.