CRM Jobs - FL2021-4049- IT Auditor (Healthcare)/Business Support III), 30711

Location Jacksonville, FL
Date Posted January 23, 2021
Category Default
Job Type Full-time


Candidate must be Authorized to work in the United States with any employer, No Visa Sponsorship, No C2C candidates please, No Third Party agencies. This is a direct hire role.

Job Title: FL2021-4049- IT Auditor (Healthcare)/Business Support III)

Location: O pen to 100% remote

Duration: 6 Months

Job Summary:

This position is responsible for assisting in the development, implementation, and oversight of operations compliance across the Medicare organization. This includes consulting and evaluating compliance with federal requirements and applicable state laws; developing business strategies to achieve business outcomes; on-going monitoring and audit assessments; collaborating with business areas on monitoring and oversight results; and developing/overseeing the execution of corrective action plans.

Essential Functions:

The essential functions listed represent the major duties of this role, additional duties may be assigned.

Monitoring and Oversight

Collaborate with Ops compliance leadership to design and develop Medicare compliance oversight, monitoring and evaluation programs to ensure the entire Medicare organization is compliant with all applicable state and federal laws and regulations

Research, analyze, validate and gather business process data to assess the effectiveness of the controls to ensure compliance and identify trends. Recommend improvements to ensure compliance.

Track, measure, and report any identified compliance issues to Medicare leadership. Oversee the issues and work back with compliance champions for short-term and long-term resolution.

Consult with senior business area leaders and subject matter experts on corrective action plans to improve compliance metrics and audit findings, as required.

Communicate KPI and audit results monthly to both Business, Ethics, Integrity, and Compliance (BEIC) and Florida Blue Medicare leadership. Analyze dashboard metrics, business area reports and audit results to identify and make recommendations for operational improvements and/or corrective action measures.

Develop compliance dashboards, monitor and communicate results to applicable senior business area leaders and compliance leadership.

Consult with business areas on new projects and define compliance requirements.

Identify existing organizational or operational compliance risks and opportunities, work with business area leadership and subject matter experts to implement improvement and/or corrective action measures, and monitor ongoing compliance.

Years of Experience:

5+ years compliance or regulatory experience specific to the Healthcare/Health Insurance industry

Experience Details:

Compliance or regulatory experience (e.g. training, auditing, monitoring, investigations, issue resolution, risk management, and development and monitoring of corrective actions)


Related Bachelor’s degree or additional related equivalent work experience, Business or health related field

Master’s degree, Business or health related field

Additional Required Qualifications:

Comprehensive knowledge of health insurance products and the associated sales, service, claims, and enrollment and billing processes

Knowledge of documenting walkthroughs, narratives, and flows for control identification and testing

Excellent verbal and written communication skills

Must possess strong problem solving and decision making skills

Must be confident interacting with people and have the ability to be persuasive

Proficient in Word, Excel and PowerPoint

Demonstrated organization, facilitation, communication and presentation skills

Preferred Qualifications:

Professional certification as a Certified Internal Auditor, Certified Fraud Examiner, Certified Public or Management Accountant, Certified Compliance and Ethics Professional, or Certified Information Privacy Professional

Project Management, Six Sigma, Lean

Additional Preferred Qualifications:

Advanced Excel skills

Intermediate experience with MS Word and PowerPoint

Able to consume and make decisions with data

Experience working with regulatory agencies

Experience working with health insurance processing systems (RBMS, Siebel, Diamond, Jiva, etc.)

Detailed knowledge of applicable state and federal regulations and experience with the design and implementation of program safeguards to ensure organizational Medicare compliance.

General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Candidate must be Authorized to work in the United States with any employer, No Visa Sponsorship, No C2C candidates please, No Third Party agencies. This is a direct hire role.