a. Performs intermediate to complex level operational audits using statistical sampling methodologies, including coverage of core business transactions such as claims, membership & enrollment, and customer service.
b. Coordinates multiple audit projects , 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. Compiles and maintains audit documentation in appropriate files, databases, and systems to support audit work performed, conclusions/issues identified, and recommendations/action plans. Maintains desk level procedures for assigned audits.
e. Identifies and assesses risks and controls and tests controls for WellSOX program to ensure controls are working effectively.
f. Provides assistance to external auditors during their interim and/or yearend audit financial and for the SOC audit.
g. 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.
h. Collaborates with fraud investigation unit in the performance of fraud investigations, including data compilation and analysis, application of fraud investigation techniques, and reporting of conclusions and results.
i. Abides by the Standards for the Professional Practice of Internal Auditing.
j. Other duties as assigned.