Andy Bougie, Cia, Cfe Email & Phone Number

Atlanta, Georgia, United States

Perform reviews of documentation provided by health insurance companies supporting Medical Loss Ratio (“MLR”) calculations and distribution of rebates to enrollees.Perform attribute and accuracy testing of premium and claims transactions, and other major components of the MLR calculation.Interpret MLR regulations, filing instructions and technical guidance in comparison to documentation provided by health insurance companies.Prepare documentation of clear, concise, and informative conclusions on required MLR examination procedures.

Farmington, Ct

Perform financial and compliance examinations of domestic and foreign insurance companies. Examine and analyze fiscal and control data involving audits and examinations of insurance companies for adherence to state laws and evaluation of control environment.FOCUS: Certified Internal Auditor, Certified Fraud Examiner, Certified Financial Examiner, Financial Analysis, Financial Statements, Regulatory Compliance Audits, Operational Compliance Audits, Risk Assessments, Enterprise Risk Management, Fraud Assessments, Internal Controls, Client Relationship Management, Project Management, Internal Audits, Leadership, Conflict Resolution, Negotiation, Communication, Compliance Regulations, Regulatory Compliance, KPI, Key Performance Indicators

Perform financial and compliance examinations of domestic and foreign insurance companies. Examine and analyze fiscal and control data involving audits and examinations of insurance companies for adherence to state laws and evaluation of control environment.FOCUS: Certified Internal Auditor, Certified Fraud Examiner, Certified Financial Examiner, Financial Analysis, Financial Statements, Regulatory Compliance Audits, Risk Assessments, Fraud Assessments, Internal Controls, Client Relationship Management, Project Management, Leadership, Conflict Resolution, Negotiation, Communication, Compliance Regulations, Regulatory Compliance, KPI, Key Performance Indicators

Perform financial and compliance examinations of domestic and foreign insurance companies. Examine and analyze fiscal and control data involving audits and examinations of insurance companies for adherence to state laws and evaluation of control environment.FOCUS: Certified Internal Auditor, Certified Fraud Examiner, Certified Financial Examiner, Financial Analysis, Financial Statements, Regulatory Compliance Audits, Risk Assessments, Enterprise Risk Management, Fraud Assessments, Internal Controls, Client Relationship Management, Project Management, Leadership, Conflict Resolution, Negotiation, Communication, Compliance Regulations, Regulatory Compliance, KPI, Key Performance Indicators

Perform financial and compliance examinations of domestic and foreign insurance companies licensed to sell insurance in the State of New Hampshire.Examine and analyze fiscal and control data involving audits and examinations of insurance companies for adherence to state laws and evaluation of control environment.FOCUS: Certified Internal Auditor, Certified Fraud Examiner, Certified Financial Examiner, Financial Analysis, Financial Statements, Regulatory Compliance Audits, Risk Assessments, Enterprise Risk Management, Fraud Assessments, Internal Controls, Client Relationship Management, Project Management, Leadership, Conflict Resolution, Negotiation, Communication, Compliance Regulations, Regulatory Compliance, KPI, Key Performance Indicators

Took the lead in ensuring full-cycle SOX (CLEAR) compliance while closely liaising between Circle’s and Group CLEAR Project Management Office. Advised process owners in the definition and scoping of requirements as well as in the drafting, review and/or editing of existing or new control documentation. Tracked and ensured follow through of Action Plans by process owners. Maintained and updated master summary of key controls, company level controls and critical applications.FOCUS: Certified Internal Auditor, Certified Fraud Examiner, Financial Analysis, Financial Statements, Operational Compliance Audits, Risk Assessments, Fraud Assessments, SOX Compliance, Sarbanes-Oxley, Internal Controls, Client Relationship Management, Project Management, Internal Audits, Leadership, Conflict Resolution, Negotiation, Communication, KPI, Key Performance Indicators

Audited processes including Financial Reporting, Claims Management and Revenue Recognition in domestic and international locations to ensure strict compliance with all SOX regulations. Worked in close collaboration with senior management and business unit representatives to remediate issues identified during testing. Counseled staff on effective operational and internal control mechanisms and documentation procedures.Provided complete documentation for SOX compliance and employee orientation by designing and creating all related process narratives and workflows. Ensured the timely completion of SOX testing by developing and monitoring testing budgets and plans. Developed and executed operational test steps to better assess operational effectiveness.FOCUS: Certified Internal Auditor, Financial Analysis, Financial Statements, Operational Compliance Audits, Risk Assessments, Fraud Assessments, SOX Compliance, Sarbanes-Oxley, Internal Controls, Client Relationship Management, Project Management, Internal Audits, Leadership, Conflict Resolution, Negotiation, Communication, KPI, Key Performance Indicators

Held accountability for the timely and effective execution of operational, financial and compliance audits in strict compliance with the Professional Standards of the Institute of Internal Auditors. Prepared and distributed all applicable audit communication.FOCUS: Certified Internal Auditor, Financial Analysis, Financial Statements, Regulatory Compliance Audits, Operational Compliance Audits, Risk Assessments, Fraud Assessments, SOX Compliance, Sarbanes-Oxley, Internal Controls, Client Relationship Management, Project Management, Internal Audits, Leadership, Conflict Resolution, Negotiation, Communication, Compliance Regulations, Regulatory Compliance, KPI, Key Performance Indicators

Graduate Certificate, Fraud Investigation And Forensic Accounting

Bachelors, Business/Accounting