a. Performs entry to intermediate level operational audits using statistical sampling methodologies, including coverage of core business transactions such as claims, membership & enrollment, and customer service.
b. Performs audit projects as assigned, including issue identification and coordination of corrective action plans in accordance with regulatory and Blue Cross Blue Shield Association BCBSA guidance.
c. Compiles and reviews populations of transactional data against established parameters for accuracy and completeness. Develops and documents samples to be audited in accordance with audit requirements.
d. Prepares reports summarizing audit findings, and assists with presentations to operational stakeholders. Collaborates with business unit leaders to develop and monitor corrective action plans for identified audit issues.
e. Compiles and maintains audit documentation in appropriate files, databases, and systems to support audit work performed, conclusions/issues identified, and recommendations/action plans.
f. Maintains and continually improves understanding of Wellmark’s business and business environment including compliance with laws and regulations, new products and services offered by Wellmark, organizational structure, corporate policies, and Wellmark’s strategic direction.
g. Assists with external audits conducted on behalf of large group accounts, including document preparation, analysis, and research for development of audit responses.
h. Assists in fraud investigations, including data compilation and analysis, as directed by the lead investigator.
i. Abides by the Standards for the Professional Practice of Internal Auditing.
j. Other duties as assigned.