Role Description

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:

• Leading audits and presenting audit findings
• Assisting the Audit Coordinator in monitoring and managing findings from recurring claims quality assurance audits
• Identifying root causes and offering recommendations for positive change
• Conducting audit planning and supervising fieldwork
• Ensuring compliance with Global Internal Audit Standards and G.E.H.A Internal Audit methodologies
• Providing expertise in the review, research, and analysis of claim exceptions
• Delivering training to less experienced team members
• Adhering to corporate policies and professional ethical standards
• 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 30×5 (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

Benefits

• Competitive pay/salary ranges
• Incentive plan
• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
• Robust employee well-being program
• Paid Time Off
• Personal Community Enrichment Time
• Company-provided Basic Life and AD&D
• Company-provided Short-Term & Long-Term Disability
• Tuition Assistance Program