Director of Audit

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🌽 Illinois, Nebraska, +2 estados a mais – Remoto

🌽 Illinois – Remote 🌾 Nebraska – Remote 🌲 Oregon – Remote ⚔️ Virginia – Remote

💵 $150.000 - $200.000 / ano

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Blue Cross Blue Shield Association

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1960

⚕️ Seguro de Saúde

🤝 Sem Fins Lucrativos

Healthcare Insurance • Non-profit

A Blue Cross Blue Shield Association é uma associação de empresas independentes, operadas localmente, dedicadas a oferecer planos de seguro de saúde acessíveis e abrangentes. Oferece uma ampla gama de planos de saúde para indivíduos, famílias e empregadores, incluindo opções do Medicare. A Blue Cross Blue Shield Association está comprometida em promover a equidade em saúde e apoiar iniciativas de saúde mental, com o objetivo de tornar o atendimento à saúde fácil, acessível e disponível para todos. A associação é ativa em pesquisa de cuidados de saúde e advoga por um sistema de saúde mais equitativo.

Descrição

• Overseeing the organization’s client and pharmaceutical rebate audit function and ensuring the effectiveness of financial, operational, and contractual compliance controls across the enterprise. • Leading the planning and execution of audit programs, identifying risk exposures, and providing actionable recommendations to enhance operational execution, governance, efficiency, and compliance. • Closely working with executive leadership to promote a strong internal control culture and continuous improvement mindset. • Leading and overseeing pharma and client audits for Synergie. • Supporting SOC audit evidence gathering for annual audit. • Evaluating the efficiency and effectiveness of internal controls, processes, and risk management frameworks. • Monitoring corrective action plans, ensuring timely resolution of audit findings. • Developing and executing the annual risk-based audit plan aligned with organizational strategy and regulatory requirements.

🎯 Requisitos

• Bachelor’s degree in business, healthcare, or other related field; Master’s degree preferred. • 8+ years of work experience in a health care auditing role, with expertise in health plans, health systems, pharmacy, and managed care or specialty pharmacy. • Must include at least 3 years of experience in medical and/or pharmacy drug management at a health plan or PBM. • Strong experience managing external audit vendors during audits • Strong understanding of audit practices • Experience designing and executing audit programs. • Strong data management and analytics skills with the ability to manage large data effectively. • Strong knowledge of medical and pharmacy rebates, value-based contracts, and invoicing processes. • Demonstrated ability to lead cross-functional teams, drive results in a fast-paced environment, and manage client support while ensuring alignment with Synergie’s objectives. • Ability to develop relationships and influence with internal and external stakeholders. • Excellent leadership, communication and critical thinking skills and ability to anticipate issues and develop solutions. • Must be eligible to work in the United States without need for work visa or residency sponsorship.

🏖️ Benefícios

• paid time off • 11 holidays • medical/dental/vision insurance • generous 401(k) matching • lifestyle spending account