Full-Time Manager - External Audit

The Mgr – External Audit will lead a variety of audits and advisory engagements and will directly supervise the claim audit team members and external third-party auditors. The role will include:

1. Leading audits and presenting audit findings
2. Assisting the Audit Coordinator in monitoring and managing findings from recurring claims quality assurance audits
3. Identifying root causes and offering recommendations for positive change
4. Conducting audit planning and supervising fieldwork
5. Ensuring compliance with Global Internal Audit Standards and G.E.H.A Internal Audit methodologies
6. Providing expertise in the review, research, and analysis of claim exceptions
7. Delivering training to less experienced team members
8. Adhering to corporate policies and professional ethical standards
9. Communicating with G.E.H.A employees, management, vendors, and contractors

Qualifications

• Requires a college degree (BA/BS) from an accredited college/university
• 5 to 8 years of relevant audit and/or claim processing experience
• 3 or more years of leadership experience
• Superior analytical, research, and critical thinking skills
• Project, organizational, and time management skills
• Leadership skills with the ability to motivate and influence
• Strong verbal, written, and interpersonal communication skills
• Proficiency in Microsoft Office Applications (Excel is critical)
• Working knowledge of claims processing, medical terminology, and medical codes
• Knowledge of claim system configuration, Claims (Medical/Dental), Enrollment, or Internal Operations functions
• Ability to work independently and prioritize workflow

Requirements

• Experience with data analytics software and tools preferred (e.g., IDEA, PowerBI, SQL)
• Ability to provide a non-cellular High Speed Internet Service for a home office
• Minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload)
• Latency (ping) response time lower than 80 ms
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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