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!
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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.
Required:
Preferred:
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".
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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!
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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