Client Audit Specialist, PBM

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee regulatory and/or client-driven audits either independently or in collaboration with senior personnel and compliance leadership.

• Analyze and interpret audit requests to establish the scope, affected business areas, stakeholders, and necessary evidence.

• Present sample cases or evidence data while acting as a subject matter expert on business requirements, systems, processes, regulations, and accreditation standards.

• Cultivate and maintain relationships with internal and external stakeholders to offer audit consultation and enhance workflow efficiency.

• Track audit progress, identify and mitigate risks, escalate issues, and suggest remediation strategies.

• Conduct quality reviews and evaluate audit deliverables for adherence to contractual and regulatory standards.

• Ensure stakeholders comprehend and fulfill their audit responsibilities accurately and promptly.

• Keep comprehensive audit records and prepare deliverables, reports, findings, recommendations, and communications regarding audit results.

• Direct audit strategy, deliverables, requirements, milestones, and accountability by utilizing project management and organizational skills.

• Assist in departmental enhancement initiatives and maintain training and procedural documentation.

• Execute additional duties as assigned.

⛳️ Requirements

• A bachelor's degree in Business, Health Care Services, or a related field, or a suitable combination of education and/or relevant work experience.

• A high school diploma from an accredited institution or an equivalent GED is required.

• Minimum of 2 years of pertinent work experience in audit, compliance, or operations within a regulated setting.

• Must have eligibility to work in the United States without requiring a work visa or residency sponsorship.

• Strong verbal and written communication, along with effective presentation skills.

• Excellent interpersonal skills, including meeting facilitation, conflict resolution, consensus-building, and collaboration abilities.

• Strong critical thinking and analytical skills; capability to navigate ambiguous, complex, and challenging scenarios.

• Organizational, prioritization, and attention-to-detail skills; capacity to manage multiple complex projects under pressure and stringent deadlines.

• Agility and adaptability in a fast-paced, dynamic, and high-pressure matrix environment.

• Ability to exercise independent judgment and make critical decisions in assessing audit processes and evidence.

• Proficiency in Microsoft Office Suite, particularly Word and Excel, at an intermediate to advanced level.

• Preferred: Experience in health insurance/PBM operations and/or contract auditing.

• Preferred: Background in regulatory compliance for Medicare, Medicaid, Commercial, or ACA drug benefits.

• Preferred: Experience in project management.

• Ability to perform essential job functions; reasonable accommodations may be provided.

🏝️ Benefits

• Benefits, incentives, and additional compensation options are available; further details are outlined on the Benefits Page.

• We are an equal opportunity and affirmative action employer.

• Reasonable accommodations are offered for applicants with disabilities.

• Tobacco-Free Workplace.