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Sr Performance Auditor - FEP

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.

Job Description

In this role the Sr Performance Adutitor will perform complex audits of core business processes, including claims payment, member benefits and enrollment, customer service inquiries, and provider contracts, with a focus on the Federal Employee Program (FEP) requirements. Responsible for demonstrating professional skepticism while performing intermediate-to-complex evaluations against program requirements to help leadership manage risk and identify and develop compensating controls. Support FEP external audit activities conducted by government and regulatory agencies and the Blue Cross Blue Shield Association requirements, including OIG/OPM. Must apply knowledge, skill, and experience over a broad range of technical program requirements and related business transaction processing functions.

Qualifications

Required:

  • Bachelor's degree in accounting or related field, or equivalent work experience.
  • Minimum of 4 years finance, auditing and/or business experience within the health insurance or related industry. Competent analytical skills, with the ability to analyze data and make recommendations
  • Skilled attention to detail with the ability to complete tasks accurately and completely keeping business regulations and rules in mind.
  • Practiced communication skills, both verbal and written.
  • Ability to be flexible and adaptable while recommending changes to workflow to improve processes while guiding others through it. Practiced understanding of how business risk affects business strategy.
  • Demonstrated interpersonal skills with the ability to build, maintain and leverage business relationships and consultation skills to drive results.
  • Ability to coach and mentor others by providing guidance and feedback to help strengthen their knowledge and skills. Travel required up to 5%.

Preferred:

  • Bachelor’s degree
  • Audit/Compliance experience
  • CPA, CIA, or similar certification, or willingness to work towards certification

Additional Information

a. Perform complex level audits (with a focus on FEP Programs) using statistical sampling audit methodologies; including coverage of core business transactions such as claims, membership & enrollment, benefit design, and system coding and edits.

b. Support the External Audit Lead for FEP-related audits conducted on behalf of government and regulatory agencies, including OIG/ OPM and the BCBSA. Coordinate and manage document preparations and pre-audit, analysis, research and development of audit responses, and negotiation for final audit reporting.

c. Support External Audit Lead in coordination of multiple audit projects, including issue identification and coordination of corrective action plans in accordance with regulatory requirements and federal guidelines (i.e., OPM, OIG, HHS, CMS, DOL, BCBSA).

d. Collaborate with External Audit Lead in discussions and negotiations for any audit issues with all levels of management or applicable stakeholders. Participate in exit conferences as appropriate and perform necessary follow-up to ensure issues are resolved effectively.

e. Compile and review populations of transactional data against established parameters for accuracy and completeness. Develop and document samples to be audited in accordance with audit requirements.

f. Compile and maintain audit documentation to support audit work performed, conclusions/issues identified and recommendations/ action plans. Develop desk level audit procedures, as necessary, for assigned audits.

g. Prepare reports summarizing audit findings and results based on established metrics and in accordance with FEP and BCBSA standards. Reporting includes preparing and submitting results to BCBSA on a quarterly basis. Will communicate results to leadership, including presentations as requested.

h. Maintain and continually improve 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.

i. Abide by the Standards for the Professional Practice of lnternal Auditing and the Code of Ethics.

j. Responsible for mentoring and coaching performance auditing staff by providing quality assurance feedback and subject matter expertise. Train junior level staff in audit process. Assist leadership with development and execution of the quality assurance process.

k. Serve as a liaison with BCBSA FEP audit staff and Sister Plans to identify and implement best practices for FEP-related audit activities.

l. Other duties as assigned.

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".

Average salary estimate

$85000 / YEARLY (est.)
min
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$75000K
$95000K

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What You Should Know About Sr Performance Auditor - FEP, Wellmark, Inc.

If you're ready to take your career to the next level, Wellmark Blue Cross Blue Shield has an exciting opportunity for you as a Senior Performance Auditor focused on the Federal Employee Program (FEP) in beautiful Des Moines, IA. At Wellmark, we pride ourselves on being a trusted insurance provider for over 80 years, centered around improving the well-being of our members rather than purely chasing profits. As a Senior Performance Auditor, you'll be diving into complex audits of core business processes like claims payment and member benefits. You'll bring your analytical expertise to evaluate against program requirements, ensuring effective risk management and control development. In addition to your auditing responsibilities, you will also support external audit activities driven by regulatory agencies and the Blue Cross Blue Shield Association. Your role will be crucial in facilitating discussions with management and stakeholders, ensuring compliance with federal standards, and mentoring junior auditors. With a balanced approach to flexibility and attention to detail, we expect you to thrive in analyzing and improving workflows while guiding your peers through the auditing process. If this sounds like a fit for you, let's help our members experience top-notch service together at Wellmark!

Frequently Asked Questions (FAQs) for Sr Performance Auditor - FEP Role at Wellmark, Inc.
What are the key responsibilities of a Senior Performance Auditor at Wellmark?

As a Senior Performance Auditor at Wellmark, you will perform intricate audits focused primarily on the Federal Employee Program (FEP). Your role will entail evaluating claims payments, member benefits, and provider contracts, while also ensuring compliance with regulations set by government and regulatory bodies. Additionally, you'll put your analytical skills to work by assessing risk and developing control measures, all while mentoring junior staff and supporting external audits.

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What qualifications do I need to become a Senior Performance Auditor at Wellmark?

To qualify for the Senior Performance Auditor position at Wellmark, you need to hold a Bachelor’s degree in accounting or a related field, or have equivalent work experience. A minimum of four years in finance, auditing, or a related field within health insurance is essential. Having strong analytical skills, attention to detail, and effective communication abilities is a must. Certifications such as CPA or CIA are preferred but not mandatory, as there’s room for growth in this area.

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How can I prepare for the role of Senior Performance Auditor at Wellmark?

To prepare for your role as a Senior Performance Auditor at Wellmark, familiarize yourself with federal regulations governing the Federal Employee Program (FEP) and health insurance audits. Strengthening your analytical skills and gaining experience with complex auditing methodologies will be beneficial. Additionally, developing your communication and interpersonal skills will enhance your ability to work with diverse teams and stakeholders.

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Does the Senior Performance Auditor role at Wellmark require travel?

Yes, the Senior Performance Auditor position at Wellmark requires travel of up to 5%. This travel will likely involve engaging with external auditors and facilitating communications with various regulatory bodies as necessary, ensuring that you remain updated and compliant with requirements that affect our auditing processes.

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What opportunities for growth and development are available in the Senior Performance Auditor position at Wellmark?

Wellmark is committed to the professional growth of its employees. As a Senior Performance Auditor, you'll have opportunities to mentor junior staff, develop your expertise in audit methodologies, and gain exposure to regulatory environments. Additionally, pursuing certifications such as CPA or CIA will be supported by our organization, helping you to advance your career in auditing and compliance within the insurance sector.

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Common Interview Questions for Sr Performance Auditor - FEP
Can you explain your experience with auditing core business processes?

When answering this question, highlight specific instances where you have conducted audits of business processes like claims payments or member benefits and discuss the methodologies you used to ensure accuracy and effectiveness.

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What strategies do you use for analyzing data in audits?

Discuss your approach to data analysis by mentioning the tools and techniques you leverage, such as statistical sampling or analytical software, and how these strategies have led to actionable recommendations in previous roles.

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How do you communicate audit findings to management?

Your response should demonstrate your ability to present findings clearly and concisely, using reports and presentations to effectively convey both positive outcomes and areas for improvement, ensuring that all key stakeholders understand the implications.

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What is your experience with external audits and regulatory compliance?

Share your background in supporting or coordinating external audits, highlighting any interactions with regulatory agencies and how you ensured adherence to compliance standards during these processes.

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Describe a time when you identified a significant business risk during an audit.

Provide a specific example detailing the risk you identified, the steps you took to analyze it, and the recommendations you made to mitigate that risk, showcasing both your analytical skills and proactive approach.

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How do you stay updated on changes in audit regulations?

Emphasize your commitment to continuous learning, sharing methods such as joining professional organizations, attending workshops, and reading industry publications to keep abreast of evolving regulations and compliance requirements.

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Can you discuss your experience with mentoring junior auditors?

Highlight your past mentoring experiences, detailing how you provided guidance and support, as well as any specific outcomes that resulted from your mentorship, to illustrate your leadership qualities.

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What tools or frameworks have you used for auditing?

Mention specific auditing frameworks you are familiar with, such as COSO or IIA standards, along with any software tools that you have successfully implemented in past auditing roles to enhance your efficiency and effectiveness.

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How do you prioritize your audit tasks when managing multiple projects?

Discuss your methods for assessing priorities based on project deadlines, regulatory requirements, and stakeholder impact, illustrating how you maintain organization and focus in a multi-project environment.

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What do you believe is the most critical quality for a Senior Performance Auditor?

Articulate your understanding of critical qualities such as attention to detail, analytical thinking, and strong communication skills, and provide examples of how you embody these qualities in your work.

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Wellmark, headquartered in Des Moines, Iowa, and established in 1939, is a health insurance company specializing in individual and family health insurance plans.

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Full-time, on-site
DATE POSTED
December 31, 2024

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