Audit Data Analytics - Insurance

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Risk & Regulatory Consulting LLC

Audit Data Analytics - Insurance

(Remote-USA based)

Position Overview

The Audit Data Analytics Manager will lead the development and execution of data-driven strategies to enhance audit quality, efficiency, and insights. This role combines technical expertise in data analytics with a deep understanding of audit processes to deliver innovative solutions that support risk assessment, testing, and continuous monitoring. The Data Analytics specialist will work with a team of industry professionals on regulatory consulting and other insurance and pharmacy benefit manager (PBM) industry engagements. This position has significant opportunity for advancement as well as personal and professional growth. The ideal candidate has deep knowledge of insurance and PBM data structures, regulatory frameworks and modern analytics tools. This role requires the ability to be able to translate complex algorithms and datasets into actionable regulatory findings and clearly communicate with internal and external clients.

Specific Duties and Responsibilities

Knowledge:

• Review regulatory programs, statutes, and laws to confer with management and users to identify and resolve any issues or concerns.
• Evaluate risk within the audit and governance structures around insurance and PBM automated systems in the categories of potential delay of policy benefits, unfair claim denials/adjustments, algorithmic bias, disparate impact of data lineage, quality controls and integrity of datasets.
• Ensure analytics solutions comply with regulatory requirements and client requirements.
• Partner with other teams (e.g., market conduct, financial, IT, and other stakeholders) to ensure data integrity and accessibility of key information and data.
• In-depth knowledge of sampling methodologies (attribute sampling and monetary unit sampling).

Skills:

• Analyze large datasets to identify anomalies, trends, and potential control weaknesses.
• Design and implement advanced analytics solutions to support project objectives.
• Develop dashboards, visualizations, and automated tools for engagement teams.
• Collaborate with examiners to integrate analytics into planning, fieldwork, and reporting. Maintain clear documentation (i.e., audit trail) to support methodologies and processes.
• Create sample sizes using ACL (or equivalent software, such as IDEA).
• Identify opportunities to improve examination coverage and efficiency through data-driven techniques.
• Import data files into databases (such as Microsoft Access or SQL Server) as well as software such as ACL or IDEA, Python, Power BI and Tableau.
• Define computed fields to calculate new values.
• Use scripting to preserve the ACL commands used for data analysis and data mining to create an ACL script, edit commands in a script, and to define fields.
• Utilize Statistical Profiling to create charts and graphs to produce a picture of a dataset to identify anomalies, bias, outliers, and potential regulatory violations.
• Provide value-added suggestions and ideas for improving effectiveness and efficiency of work plan steps, using data analysis and data mining techniques that also involve the fast-growing artificial intelligence supported decision systems and automated workflows.
• Extract data sets and perform data analysis based on pre-defined project scope and criteria.
• Provide consultation and support services on process improvement, data governance, artificial intelligence, and data analysis.
• Monitor project budget using client invoices and expense information with the ability to forecast budget shortfalls in advance.
• Manage and obtain approvals for any change in scope to work plan.
• Conduct client status meetings, review deliverables, receive client sign-off, escalate issues and communicate client opportunities.
• Maintain an active network in the business community, leveraging client relationships to provide valuable insight to state regulatory clients.

Attributes:

• Analytical Thinking: Interpret data, identify trends, and provide meaningful insights to project in-charges and engagement team leadership.
• Professionalism: Represent the firm with polish and discretion; model leadership behaviors; interact with all levels including executives and senior managers; possess excellent organizational skills; and prioritize multiple tasks, projects and assignments.
• Adaptability: Thrive in a fast-moving environment with shifting priorities and multiple client projects.
• Interpersonal Effectiveness: Build strong working relationships across multiple engagement client service teams; communicate with clarity and tact; demonstrate exceptional written and verbal communication skills.
• Self-Awareness: Maintain flexible demeanor; demonstrate self-motivation, and possess a sense of urgency.
• Leadership & Coaching: Guide junior staff, provide feedback, and ensure quality and consistency in deliverables; demonstrate ethical and professional standards as outlined by the Firm.
• Teaming With Others: Collaborate with other key constituents in a forward-thinking manner; be recognized as a valued "go to" resource.
• Technical Agility: Stay on top of learning new technologies and leverage technologies to automate or streamline processes to drive efficiencies in the execution of project requirements.
• Resourcefulness: Anticipate client and engagement team member needs, solve problems proactively, and support continuous improvement efforts.

Required Qualifications

• Bachelor's degree in Data Analytics, Computer Science, Finance, Risk Management, Accounting, or related field
• 5+ years of insurance industry experience
• Strong understanding of ERP systems and data structures
• Knowledge of emerging technologies such as AI and machine learning in audit contexts
• Experience with IT security in areas such as: Windows, Unix, routers, switches, database environments, web security, firewall and IDS/IPS, RACF, ACF2, z/OS, wireless
• Understanding of basic data warehousing architecture, database concepts such as normalization and denormalization, and the difference between OLTP (On-Line Transaction Processing) and OLAP (On-Line Analytical Processing)
• Proficiency in SQL, Python, or R for data analysis
• Proven experience with audit analytics tools (e.g., ACL, IDEA) and data visualization platforms (e.g., Power BI, Tableau)
• Ability to conduct fact-finding research and utilize problem-solving techniques
• Ability to collect, evaluate, and analyze large data files to identify patterns and develop phases of regulatory recommendations
• Ability to organize data into logical format for presentations in regulatory reports, documents and other written materials
• Ability to present and communicate complex data issues and solutions to both internal and external clients
• Demonstrated problem-solving skills to write code
• Demonstrated history of project management experience
• Strong interpersonal, presentation, analytical and statistical sampling skills
• Skilled in team building and team development

Preferred Qualifications

• MBA degree or above
• Professional certifications such as CISA, CISSP, CPA, CIA
• IT audit/examination experience
• Knowledge of extract software
• Experience in PBM pricing, formulary management, or rebate contracting
• Experience in auditing automated claims engines or underwriting systems
• Knowledge of CMS Part D operations, drug pricing methodologies and pharmacy claim workflows
• Experience in PBM data analytics, special investigations or AI risk management programs.
• Experience working with TeamMate

Risk & Regulatory Consulting, LLC (RRC) was formerly a business segment of RSM US LLP (formerly McGladrey) until 2012 when the separate legal entity was formed. RRC is a strategic business partner with RSM providing actuarial and insurance industry consulting services to RSM clients.

Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 130 experienced insurance professionals located in 22 states, RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. We are a results-oriented firm committed to success that builds long-term relationships with our clients.

RRC is managed by seven partners and our practice includes full time professionals dedicated to our regulatory clients. We are focused on listening to our clients' needs and delivering customized examination approaches, consulting services, and training solutions that address client needs. We bring multiple service lines together to provide superior and seamless service to our clients. We are committed to training our customers and our team. We have developed various comprehensive in-house training programs that have been tailored to meet the needs of our regulatory clients. We offer competitive pricing, outstanding experience, credentials and references. RRC is an active participant in the NAIC, SOFE, and IRES.

At RSM, we offer a competitive benefits and compensation package for all our people.We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients.Learn more about our total rewards at https://rsmus.com/careers/working-at-rsm/benefits.

All applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender; sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, current or prospective service in the US uniformed service; US Military/Veteran status; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law.

Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership.RSM is committed to providing equal opportunity and reasonable accommodation for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the recruiting process, please call us at 800-274-3978 or send us an email at careers@rsmus.com.

RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). If you are a recent U.S. college / university graduate possessing 1-2 years of progressive and relevant work experience in a same or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an experienced associate.

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At RSM, an employee's pay at any point in their career is intended to reflect their experiences, performance, and skills for their current role. The salary range (or starting rate for interns and associates) for this role represents numerous factors considered in the hiring decisions including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall anywhere within the stated range.