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Director of Audit - Synergie (Remote)

Blue Cross Blue ShieldBlue Cross Blue Shield·Health Insurance

Compensation

$150,000 - $200,000/year

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Posted

76 days

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About the role

The Director of Audit is responsible for overseeing the organization’s client and pharmaceutical rebate audit function and ensuring the effectiveness of financial, operational, and contractual compliance controls across the enterprise. This role also supports organizational SOC audits. This role leads the planning and execution of audit programs, identifies risk exposures, and provides actionable recommendations to enhance operational execution, governance, efficiency, and compliance. The Director works closely with executive leadership to promote a strong internal control culture and continuous improvement mindset. In addition, this role supports participants in Synergie pharma audits.

Audit Execution. 35%

  • Lead and oversee pharma and client audits for Synergie.
  • Support SOC audit evidence gathering for annual audit.
  • Ensure audit work adheres to contractual standards and organizational policies.
  • Evaluate the efficiency and effectiveness of internal controls, processes, and risk management frameworks.
  • Coordinate with external auditors and participants to ensure alignment and minimize redundancy.
  • Communicate with participants during pharma rebate audits and obtain evidence requested.

Risk Management and Compliance. 35%

  • Collaborate with Finance, Legal, and IT to strengthen controls around invoicing.
  • Monitor corrective action plans, ensuring timely resolution of audit findings. Advise on new business processes, system implementations, and policy changes from a risk perspective.
  • Assist in development and manage invoicing and audit policies and procedure.

Leadership and Strategy. 30%

  • Develop and execute the annual risk-based audit plan aligned with organizational strategy and regulatory requirements.
  • Provide strategic direction and thought leadership for audit, risk management, and internal control programs.
  • Partner with internal leaders to identify and mitigate emerging risks within invoicing and data governance of invoicing information.
  • Present findings, insights, and progress updates to Invoicing & Audit management.

Requirements:

  • Bachelor’s degree in business, healthcare, or other related field; Master’s degree preferred.
  • 8+ years of work experience in a health care auditing role, with expertise in health plans, health systems, pharmacy, and managed care or specialty pharmacy. Must include at least 3 years of experience in medical and/or pharmacy drug management at a health plan or PBM.
  • Strong experience managing external audit vendors during audits
  • Strong understanding of audit practices 
  • Experience designing and executing audit programs.
  • Strong data management and analytics skills with the ability to manage large data effectively.
  • Strong knowledge of medical and pharmacy rebates, value-based contracts, and invoicing processes.
  • Demonstrated ability to lead cross-functional teams, drive results in a fast-paced environment, and manage client support while ensuring alignment with Synergie’s objectives.
  • Ability to develop relationships and influence with internal and external stakeholders
  • Excellent leadership, communication and critical thinking skills and ability to anticipate issues and develop solutions.
  • Must be eligible to work in the United States without need for work visa or residency sponsorship. 

The compensation for this role is budgeted between $150,000 and $200,000.

#LI-Remote

This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this postingWe may ultimately pay more or less than the hiring range and this hiring range 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 bonus incentive pay. 

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. 

 

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Aplyr's read

Blue Cross Blue Shield is a collective of independent health insurers, ideal for professionals passionate about community health and complex regulatory environments.

Synthesized from recent postings & public sources

What's promising

  • BCBSA offers diverse roles in policy, data science, and healthcare solutions.
  • Strong focus on community-based health initiatives and local operations.
  • Opportunities to work on advanced projects in AI and cybersecurity.

What to watch

  • Complex organizational structure with 36 independent entities may lead to bureaucratic challenges.
  • Navigating regulatory environments can be demanding and intricate.
  • Limited public information about internal culture and employee satisfaction.

Why Blue Cross Blue Shield

  • Federation model allows for localized decision-making and community engagement.
  • Significant involvement in federal and state healthcare policy development.
  • Pioneering roles in healthcare data science and artificial intelligence.

Aplyr’s read is generated by AI from public sources. Was it useful?

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About Blue Cross Blue Shield

Blue Cross Blue Shield

Blue Cross Blue Shield

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The Blue Cross Blue Shield Association (BCBSA) is a federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies. It provides health insurance coverage to millions of Americans.

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