Performance Auditor I

US-IA-Des Moines
Job ID
212735
Category
Internal Audit
Requires Non-Compete?
No

Job Summary

Wellmark is currently recruiting for a Performance Auditor to join our team!  In this role, you will perform entry to intermediate level operational audits of core business processes, including claims payment, member benefits and enrollment, customer service inquiries, and provider contracts. You must apply knowledge, skill, and experience over a broad range of financially and operationally significant corporate operations and related business transaction processing functions.

 

Core Competencies:

  • Accountability: Owning and taking responsibility for one’s actions.
  • Business Acumen: Understanding industry, market, financial and company specific operations.
  • Collaboration and Communication: Working together; listen to other’s ideas; communicate accurately and concisely.
  • Decision Making: Consider all facts and impacts when making decisions.
  • Focus on the Customer: Consistently doing what is in the best interest of our customer. Leaving a positive impression on the customer by elevating their experience; making it simpler and educating to helping them understand.

Minimum Qualifications Required (all must be met to be considered)

  • Bachelor’s Degree
  • Prior experience in a Finance/ Accounting/ Banking/ Business related field
  • Strong communication skills, both verbal and written
  • Demonstrated interpersonal skills with the ability to build and develop collaborative relationships of trust
  • Strong attention to detail, with the ability to complete tasks accurately and completely

Hiring Specifications Preferred

  • Bachelor’s Degree in Accounting
  • Prior Auditing or Quality Review experience
  • Prior health insurance experience

Job Accountabilities

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.

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