Director, Audit

This is s HYBRID position.

Serves as the organization’s internal auditor and advisor to the Board of Directors, Audit & Corporate Compliance Committee and Executive Management Team, providing independent assurance that the internal control processes are suitably designed and operating effectively. Develops, executes and maintains an annual Internal Audit Plan, including the evaluation of internal controls in support of the Model Audit Rule (MAR). Performs advanced level professional internal auditing as well as advisory services to support the overall corporate governance structure. This position advises individuals across the organization and works continuously to develop, maintain, and execute a risk-based internal controls program, including the assessment, training, oversight, monitoring and auditing, as well as the remediation of controls. This position effectively communicates internal control issues and applicable risk mitigation efforts to the Board of Directors, Audit & Corporate Compliance Committee, and Executive Management Team. This position partners with external auditors, consultants and regulatory bodies to address areas of risk. This position coordinates with legal counsel and all departments across the organization to support the examinations and reviews performed by certain regulatory agencies. This position also serves as the leader of payment integrity, working cross functionally throughout the organization with an emphasis on the validation of coding, documentation, and contract application.

Reports administratively to the Chief Financial Officer and functionally to the Chair of the Audit & Corporate Compliance Committee.

Required:

1. Bachelor’s degree in accounting or finance from an accredited college or university;
2. A minimum of 10 years of full-time experience in auditing, accounting, business analysis, and corporate compliance management, including a minimum of five years in a leadership position;
3. Extensive health insurance industry experience;
4. Expertise in applying internal auditing and accounting principles in the health insurance field;
5. Extensive knowledge of and skill in applying internal auditing and accounting principles, practices, and management principles and preferred business practices.
6. Considerable knowledge of the Standards for the Professional Practice of Internal Auditing and the Code of Ethics developed by the Institute of Internal Auditors.
7. Familiarity with management information systems terminology, concepts and practices.
8. Knowledge of insurance industry program policies, procedures, regulations and laws.
9. Experience in conducting quality control reviews of audit work products.
10. Planning and project management experience.
11. Ability to negotiate issues and problem solve.
12. Excellent computer skills.
13. Effective verbal and written communication skills across all levels of an organization.
14. Initiative and ability to apply independent judgment.
15. Microsoft Office Skills;
16. Self-Motivator;
17. Public speaking/presentation and excellent verbal and writing skills.

Desired:

1. Experience in supervising and conducting audits in Information Systems and other areas pertinent to the industry.
2. Relevant compliance certification.
3. Certification as a CIA or CPA.

Responsibilities:

1. Development of the Annual Internal Audit Plan based on an assessment of risks associated with the business processes of the Company for presentation to and approval of the Audit & Corporate Compliance Committee.
2. Ensure that the results of these audits and reviews are communicated to the Audit & Corporate Compliance Committee and, when appropriate, management.
3. Ensure that recommendations are tracked and reported to the Audit & Corporate Compliance Committee until the issue has been satisfactorily resolved.
4. Ensure that the Internal Audit Department is adequately staffed, trained, equipped and supervised to perform assigned functions.
5. If functions are out-sourced: To directly supervise the consultants and advisors assigned. To monitor performance against the contract. To ensure that the staff assigned by the third party are adequately trained, equipped and sufficient to support the needs of the project.
6. To stay abreast of the latest developments concerning Internal Audit and health insurance.
7. Direct audit staff in the planning, organizing, documenting, directing and monitoring of Internal Audit operations, including assisting in hiring, training, coaching and evaluating staff.
8. Identify and evaluate the Company's risk areas.
9. Analyzes data obtained for evidence of deficiencies in controls, duplication of effort, fraud, waste or abuse or lack of compliance with laws, government regulations, and company policies or procedures.
10. Direct overall performance of internal audit procedures including identifying issues, developing audit criteria, analyzing evidence, documenting processes and procedures.
11. Communicate results of internal audits and advisory projects via written reports and oral presentations to Board of Directors, Audit & Corporate Compliance Committee and management.
12. Pursue professional development opportunities, including internal and external training and professional association memberships.
13. Coordination of external audit activities, including providing support as permissible under professional standards.
14. Direct and supervise the Payment Integrity Department.