Team Leader Performance Auditing and Investigation

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.

Why Leadership at Wellmark: 

Click here to learn about our strength-based approach to leadership at Wellmark.

Job Description

As Team Leader Performance Auditing and Investigation you will direct a team with accountability for corporate performance and quality audits pertaining to medical claims payments, membership/enrollment, customer service inquiries, provider data accuracy, provider contracts, and performance guarantees. This team is also responsible for contributions to Audit Services’ Master Audit Plan (MAP) and audit activities related to requests by external third parties. You'll serve as a key leader in the Audit Services department through oversight and quality review responsibilities for performance and quality audits, internal audit projects as assigned, and external audit coordination activities. Contributing to the overall corporate mission by providing leadership, planning, and daily direction to the Performance Auditors and external audit coordinators is a key role for the department. You'll also hold overall accountability for Wellmark’s testing and reporting of operational performance metrics to the Blue Cross Blue Shield Association, including the Federal Employee Program.

Qualifications

Required:

• Bachelor’s Degree in Accounting or related field
• Minimum 7 years of broad Accounting, Auditing and/or Business experience
• Minimum of 4 years Audit experience
• Leadership skills typically gained through a combination of project or informal leadership that demonstrates competencies
• Proven analytical skills, with the ability to analyze data and make recommendations
• Strong communication skills, both verbal and written, with the ability to effectively influence decisions at all levels of the organization
• Demonstrates strong use of appropriate interpersonal skills and methods to reduce tension and resolve conflict
• Strong attention to detail, with the ability to complete tasks accurately and completely
• Travel required between 5-10%

Preferred:

• CPA, CIA or CFE designation or MBA
• Prior direct supervisory experience

Additional Information

a. Provides oversight and leadership for complex performance and quality audits using statistical sampling methodologies, including coverage of core business transactions such as claims, membership & enrollment, and customer service. Stays abreast of the various program requirements and emerging risk issues facing the organization from an operational perspective.

b. Leads, develops, motivates, and coaches staff to support business objectives and produce results that are effective, accurate, timely, and meet or exceed stakeholder needs. Works collaboratively with senior leadership to identify ways to continue to improve Wellmark’s environment and culture. 

c. Manages and prioritizes workload to ensure all required audits for BCBSA, FEP, BlueCard, provider data and performance guarantees are completed efficiently and submitted by established due dates.

d. Develop and maintain procedures to assess the validation of integrity and accuracy of populations and samples used by the team to perform testing.

e. Performs and provides oversight of root cause analysis, including communication of audit trends to business units. Provides oversight and quality review of reports summarizing audit findings and discusses results with business units and other stakeholders. Negotiates and develops appropriate corrective action plans in collaboration with the business units and senior leadership. Builds and enhances productive relationships with business stakeholders.

f. Direct and manage work completed by external audit coordinators. Ensure regulatory audits (FEP/OPM and other regulatory entities) are completed in accordance with instructions and by established deadlines. Manage workload of coordinators related to group audits, from audit initiation through issue resolution and reporting. Identify opportunities for future audits based on audit findings and observations.

g. Support Wellmark’s Financial Controls Manager by assisting with assigned financial statement and SOC1 audit work, including scheduling of work, periodic status updates, and quality review of worked performed by Performance Auditors.

h. Provide oversight to Performance Auditors as they are trained on the Internal Audit approach and develop skill sets related to the Internal Audit function. Collaborate with other departments and corporate leadership to develop skills of Performance Auditors, preparing them for potential future roles in Internal Audit or within the business units.

i. Mentor and coach staff through assigned projects, including assistance with risk assessment and project scoping, collaborating with other department leadership on setting budgets and target dates, resolving conflict, and establishing corrective action plans in conjunction with the business units.

j. Recommends, develops and completes projects to identify efficiencies and implement best practices within the Performance Auditing department. Assist with development of new departmental policies and procedures. Stays abreast of operational and internal audit best practices and applies knowledge to Wellmark. Ensure work completed by team complies with internal quality standards.

k. Provides training modules or identifies external opportunities for training in a program of continuing professional education for staff. Responsible for developing communications for departmental and corporate staff about changes made to processes.

l. Write reports and prepare presentations as required to share results with management up to CEO and Audit Committee of the Board of Directors. 

m. Other duties as assigned.

This job requires a non-compete agreement.

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".