Sr. Audit Specialist

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

Ready to help us transform healthcare? Bring your true colors to blue.

Reporting to the Director of Regulatory and PBM Audit, the Senior Auditor is a key member of the team responsible for the facilitation of regulatory, compliance, and Pharmacy Benefit Manager (PBM) audits. This role is critical in providing assurance to senior leadership and the Board of Directors that BCBSMA's processes and controls are effective and in compliance with all government regulations and corporate policies. This is a high‑profile position that offers significant exposure across the company, including interaction with regulators (e.g., DOI, CMS) and auditors from the Blue Cross Blue Shield Association (BCBSA). The ideal candidate is a highly organized and motivated professional with strong analytical and communication skills and a foundational understanding of BCBSMA's business.

This role is eligible for our Flex persona.

Key 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 other Internal Audit teams (including Financial, Operational, and IT Audit), Corporate Compliance, and Fraud, Waste, and Abuse (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 to stakeholders that appropriate root cause analysis has been completed and that corrective actions are effectively implemented.
• Support multiple, concurrent projects, often with tight deadlines, reporting to different project leaders.
• Maintain well‑documented and organized work papers to support the team's reporting responsibilities to executive leadership and the Audit Committee of the Board of Directors.

Challenges / Problem Solving

• Working independently and as part of a team on different projects
• Managing multiple projects with tight deadlines
• Working with different project leaders
• Ability to escalate issues or problems quickly

Decision Making Authority

• While this is an individual contributor role, the position will be responsible for ensuring audit vendors perform audits according to schedules and for escalating issues to BCBSMA timely.

Qualifications (knowledge/skills/abilities/behaviors)

• Integrity and Professionalism: Must demonstrate the highest level of integrity to establish and build trust with internal and external stakeholders.
• Organizational & Analytical Skills: Exceptional organizational, time management, and analytical skills with a keen attention to detail and the ability to manage multiple competing priorities effectively.
• Communication & Interpersonal Skills: Excellent written and verbal communication skills, with the ability to build relationships, influence others, and clearly articulate complex issues to a variety of audiences.
• Problem‑Solving: Strong problem‑solving aptitude with the ability to perform root‑cause analysis and recommend practical solutions.
• Business Acumen: General business acumen and a strong desire to learn the intricacies of BCBSMA's regulated products (e.g., MAPD, FEP), business operations, and our PBM relationship.
• Technical Skills: Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) is required.
• An understanding of audit, risk management, or compliance principles is a plus. Willingness to learn is essential.

Education / Relevant Experience (List in order of importance)

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

Location

Hingham

Time Type

Full time

Salary Range

$89,460.00 - $109,340.00

We offer a comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well‑being benefits to eligible employees.

This job is also eligible for variable pay.

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 is 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.