Audit Data Analytics - Insurance

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Risk & Regulatory Consulting LLC

Audit Data Analytics - Insurance

(Remote-USA based)

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.

• 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).

• 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…