Healthcare Regulatory Audit Lead – PBM

Blue Cross and Blue Shield of Massachusetts, Inc.; Hingham (MA); On-site; USD 89,460 - 109,340; Full time

Job summary

Blue Cross and Blue Shield of Massachusetts, Inc. is seeking a Senior Auditor to lead regulatory and PBM audits. You will ensure controls are effective and compliant, interacting with regulators and external auditors, reporting to the Director of Regulatory and PBM Audit.

The role emphasizes analytical rigor, strong communication, and collaboration across Internal Audit, Compliance, and FWA teams. A bachelor's degree and healthcare experience are required.

Qualifications

• Bachelor's degree required.
• 3+ years of experience, preferably in healthcare or health insurance.
• Experience with BCBSMA's regulated products or business operations is desirable.

Responsibilities

• Conduct, support, or facilitate regulatory and PBM audits in compliance with established policies, plans, and procedures.
• Identify gaps and opportunities for improving the efficiency and effectiveness of the end‑to‑end regulatory audit program.
• Work cross‑functionally with Internal Audit, Corporate Compliance, and FWA teams to leverage existing work and address risks.
• Manage audit inquiries, findings, and corrective action plans by working with business leaders across the organization.
• Validate and provide assurance that root cause analysis is complete and corrective actions are effectively implemented.
• Support multiple concurrent projects, often with tight deadlines, reporting to different project leaders.
• Maintain well‑documented work papers to support reporting to executive leadership and the Audit Committee.

Skills

Regulatory audits

PBM audits

Analytical skills

Communication skills

Organizational skills

Microsoft Office

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

Blue Cross and Blue Shield of Massachusetts, Inc. is seeking a Senior Auditor to lead regulatory and PBM audits. You will ensure controls are effective and compliant, interacting with regulators and external auditors, reporting to the Director of Regulatory and PBM Audit.

The role emphasizes analytical rigor, strong communication, and collaboration across Internal Audit, Compliance, and FWA teams. A bachelor's degree and healthcare experience are required.