Job Description

Your Role

The Internal Audit Services team provides independent, objective assurance and advisory services to help Blue Shield of California manage risk, strengthen internal controls, and improve business processes. The AI Internal Audit Principal will serve as a manager-level leader responsible for overseeing audit, compliance, fraud detection, and investigative work related to the use and misuse of artificial intelligence systems.

In this role, you will lead and oversee AI-focused audits looking at usage, systems, algorithms with a focus on identifying inappropriate, nefarious, fraudulent, and non-compliant activity. In this role you will essentially look for bad actors / activity via AI. Experience with fraud, compliance and investigations is preferred. The AI Internal Audit Principal will partner closely with audit leadership, business stakeholders, technology teams, data science teams, Compliance, Legal, HR, Privacy, Information Security, Corporate Security, and investigations partners to identify AI-related fraud risks, detect suspicious activity, and strengthen controls that prevent, identify, and respond to misuse of AI.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

Your Work

In this role, you will:

• Lead AI-focused internal audits, advisory reviews, and investigative projects designed to detect inappropriate, nefarious, fraudulent, unauthorized, unethical, or non-compliant AI activity
• Develop audit and investigative methodologies for detecting fraud, insider threat, compliance violations, data leakage, unauthorized automation, and misuse of internal or third-party AI platforms
• Evaluate AI system activity, user behavior, prompts, outputs, access patterns, model interactions, system logs, configuration changes, and workflow data for indicators of bad actors or suspicious activity
• Assess controls designed to prevent unauthorized disclosure of confidential, proprietary, regulated, member, provider, employee, or business-sensitive information through AI systems
• Identify emerging AI-enabled fraud risks, including AI-assisted scams, synthetic identities, prompt manipulation, deepfakes, falsified documentation, automated abuse, model circumvention, and inappropriate use of generative AI tools
• Lead cross-functional fact-finding and root-cause reviews involving suspected AI misuse, fraud, compliance violations, inappropriate data use, or circumvention of control processes
• Design continuous monitoring approaches and analytics to identify patterns of high-risk AI usage, anomalous behavior, suspicious system interactions, and potential policy violations
• Develop risk-based audit plans, control matrices, testing procedures, investigative workplans, and evidence standards for AI fraud, misuse, and compliance monitoring engagements
• Supervise and coach audit team members, including review of investigative documentation, testing evidence, workpapers, issue summaries, and audit deliverables for quality, accuracy, and audit readiness
• Communicate fraud patterns, emerging threats, root causes, control gaps, and practical recommendations to audit leadership, business partners, technology leaders, Compliance, Legal, HR, Privacy, Information Security, and executive stakeholders
• Support annual audit planning by identifying AI platforms, business processes, high-risk use cases, data sources, and enterprise initiatives that may warrant fraud-focused audit coverage
• Drive continuous improvement in AI fraud detection playbooks, control libraries, audit analytics, investigative templates, issue rating approaches, and remediation validation procedures
• Promote ethical technology use, strong accountability, effective monitoring, compliant AI adoption, and a culture that identifies and escalates inappropriate AI activity

Qualifications

Your Knowledge and Experience

• Requires a Bachelor's degree in Accounting, Information Systems, Computer Science, Data Science, Business Administration, Cybersecurity, Criminal Justice, Engineering, or related field; advanced degree preferred, or equivalent experience
• Requires a minimum of 10 years of prior related experience in internal audit, IT audit, technology risk, compliance, fraud detection, investigations, information security, data governance, model risk management, or related assurance functions
• At least 3 years of experience auditing, reviewing, investigating, governing, implementing, or monitoring artificial intelligence, machine learning, advanced analytics, automation, or data-driven decision systems
• CISA certification required, or equivalent certification such as CIA, CISSP, CRISC, CISM, CPA, CDPSE, CFE, or other relevant audit, risk, security, privacy, investigations, fraud, or technology certification
• Experience conducting fraud investigations, compliance reviews, insider threat investigations, suspicious activity monitoring, intelligence analysis, or forensic-style reviews preferred
• Strong understanding of internal audit standards, investigative documentation, audit evidence, risk assessment, control testing, issue development, root-cause analysis, remediation validation, and defensible reporting
• Working knowledge of AI misuse risks, including prompt manipulation, data leakage, model abuse, unauthorized automation, synthetic content, deepfakes, social engineering, inappropriate data use, and circumvention of controls
• Experience using analytics platforms, AI models, machine learning techniques, SQL, Python, Databricks, Tableau, log analytics, or similar tools to identify anomalous or suspicious behavior preferred
• Knowledge of healthcare fraud, financial fraud, cyber fraud, identity fraud, employee misconduct, vendor risk, third-party technology risk, or corporate investigations strongly preferred
• Ability to translate technical AI, data, and system activity into clear audit risks, investigative findings, control gaps, and practical recommendations
• Strong project management skills, including the ability to manage multiple audits, investigations, timelines, stakeholders, and deliverables
• Experience supervising, coaching, or reviewing the work of auditors, consultants, analysts, investigators, or cross-functional project teams
• Strong written and verbal communication skills, including experience presenting sensitive or complex issues to senior leadership

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About the Team

About Blue Shield of California and the Ascendiun Family of Companies

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Ascendiun, we believe in a brighter future for healthcare. As the parent to a family of four innovative healthcare companies, we're reimagining what's possible. Ascendiun is guided by the goal of transforming a dysfunctional American health care system into one worthy of our family and friends and sustainably affordable for everyone.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, and showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.