Special Investigations Unit Audit, Senior Consultant

Blue Cross & Blue Shield Association • Full-time • US DC 9th St NW, United States of America • 3d ago

The hiring range for this role is:

92,787.88 - 139,616.25

This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonusincentivepay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Description Summary:

The role involves conducting audits and ensuring compliance with federal contracts, legal mandates, and internal guidelines to prevent fraud, waste, and abuse (FWA). Supports the Special Investigations Unit (SIU) in handling internal and governmental audits, providing analysis and recommendations based on audit findings, and preparing reports on compliance activities. Provide compliance SIU contractual guidance and deliver compliance training. Participates in workgroups and delivers clear, concise reports to senior management and stakeholders at all levels.

Responsibilities include but are not limited to:

Conduct and assist the SIU in performing compliance audits and reviews to ensure adherence to government contracts, laws, and policies. Align these audit activities with the defined scope, obligations, and reporting schedules. Formulate responses, establish positions, or devise compromises on audit issues, fostering consensus. Communicate the findings, recommendations, and corrective action plans to management and stakeholders. Additionally, assist in the development of new procedures or reports to enhance efficiency and compliance 40%
Prepare annual FWA reports and share compliance results with senior leadership, internal business units, SIUs, partners, and agencies. Develop practices to enhance reporting compliance and minimize risk. 35%
Maintain compliance manuals, standard operating procedures, and compliance content related to the FWA Program. Develop content and participate in SIU training on government compliance. Identify new and emerging fraud schemes through the proficient use of analysis and proactive software applications. 20%
Collaborate with internal business units to understand diverse subjects and enhance proficiency in providing support and coverage. Communicate emerging risks, regulatory changes, and industry best practices to strengthen audit and compliance activities. 5%

Required Education, Certifications and Experience:

Education:

Required Bachelor's Degree in Accounting, Business, Finance, Analytics, Criminal Justice, or Healthcare Administration or related field; or equivalent work experience
Preferred Master's Degree in Accounting, Business, Finance, Analytics, Criminal Justice, or Healthcare Administration or related field

Experience:

5+ Years related experience Required

Knowledge Skills and Abilities:

Skilled in audit and compliance assessment in the regulated industry, familiarity with accounting and audit standards, and comprehensive knowledge of audit techniques.
Demonstrated ability to communicate effectively, orally and in writing, with excellent interpersonal and customer service skills.
Demonstrated problem-solving skills and use of inductive and deductive reasoning to propose solutions for audit and compliance findings or issues. Analytical and critical thinking skills are essential to exercise independent judgment.
Build relationships with internal and external stakeholders and convey a sense of professional confidence.
Ability to prepare various reports and analyses to support audit findings.
Knowledge of data, financial, research, and Fraud, Waste, and Abuse (FWA) analysis techniques and proactive software applications. Ability to research, analyze, and apply data/information accurately with attention to detail and accuracy with large data sets.
Excellent organizational and time management skills.
Knowledge of federal government investigative agencies is a plus.

Certifications & Licenses:

Preferred: Accredited Health Care Fraud Investigator (AHFI) - NHCAA
Preferred: Certified Internal Auditor (CIA) - Institute of Internal Auditors

Additional information:

Five or more years of experience required
Experience in internal audit or public accounting Experience in content development for presentations and training
Prior healthcare fraud investigative experience and BCBS Plan experience

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