Job Description
Audit Specialist
Serves as audit coordinator/representative for broader department audits, determining information needed and coordinating the information gathering process for the department. Using information from audits, identifies errors, determines root cause of issues, and formulates tactical recommendations for quality and process improvements. In addition, performs quality audits/reviews of departmental operations functions to determine effectiveness of the customer experience based on established policies, procedures and company guidelines. Provides effective feedback and coaching directly to operations staff and leadership to improve performance levels and ensure understanding of departmental processes and procedures. Supports the implementation of necessary remediation strategies as needed. Operational functions audited may include review of claims processing, customer service call quality, membership processing, or sales or financial process reviews. Audits may be for varied purposes, including peer reviews, high dollar claim processing, improvement of effectiveness of customer interactions and/or other individual or departmental performance improvement.
What You’ll Do
- Design and implement targeted improvement interventions to close skill gaps, validating and sustaining measurable performance improvements.
- Analyze operational quality reviews and audit findings to identify error trends, root causes, and compliance or operational risks; communicate insights to leadership.
- Partner with leaders to conduct skill gap analyses and define development goals aligned to business and sales performance needs.
- Coordinate and perform complex departmental and regulatory audits (government‑required audits), including self‑testing and risk/control assessments
- Build trust‑based coaching relationships that foster a safe learning environment and support effective knowledge transfer across teams.
- Develop and deliver in‑depth training and “deep dive” learning sessions for frontline staff and leaders focused on:
- Specific call types or transactions
- Compliance or audit driven risk areas
- System, process, or technology changes
- Recurring quality or documentation errors
- Create and maintain a centralized knowledge repository by compiling best practices from experience, audits, and research.
- Develop transition and learning action plans to support continuous performance improvement and standardized process adoption.
- Document business process, policy, and procedural changes and translate updates into training materials, workflows, job aids, narratives, and reference guides to support consistency, compliance, and continuous learning.
- Provide clear, actionable coaching and feedback—written and verbal—at the individual and team level to improve quality outcomes.
- Partner with Internal Audit and support external auditors; conduct periodic quality reviews of Quality Auditors’ work and share results with management.
- Serve as a department subject matter expert and project representative, supporting issue resolution, audit exceptions, training needs, and supplemental leadership coverage when needed.
What You Bring
- High school diploma or GED
- 3+ years of experience in related field.
Bonus Points
- Experience supporting sales or customer‑facing teams through quality assurance, audit, or enablement initiatives.
- Familiarity with healthcare operations, regulations, or compliance environments.
- Strong coaching and facilitation skills with the ability to translate audit insights into practical performance improvements.
What You’ll Get
- The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
- Work-life balance, flexibility, and the autonomy to do great work
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
- Learn more
#LI-Hybrid
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
$50,337.00 - $80,539.00
Skills
_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.