Compliance Audit Expert

3 weeks ago


Oakland, California, United States Blue Shield of California Full time
Job Overview

The Compliance Audit Services team at Blue Shield of California oversees all functions of an effective Compliance Program, ensuring compliance with contractual and regulatory requirements.

About the Role

You will report to the Senior Director, Compliance Audit Services, and be responsible for monitoring and oversight of operational business areas. You will interface with other departments regarding implementation of new or updated regulatory mandates, act as a subject matter expert for regulatory inquiries, and support the Compliance Program as needed.

Your Responsibilities
  • Prepare and submit standard and non-standard insurance documents, researching complex issues and recommending solutions;
  • Evaluate adequacy of insurance contract requirements and provide recommendations;
  • Develop new processes and procedures to ensure consistency, accuracy, and efficiency of coordination activities related to risk;
  • Coordinate routine and non-routine processes for insurance application activities between the Company, brokers, and liability insurance carriers;
  • Analyze potential loss areas and define appropriate loss protection;
  • Direct the work of stakeholders or lead cross-functional teams;
  • Work collaboratively on large, complex projects of strategic importance;
  • Prepare clear and concise documentation and leadership reporting;
  • Leverage industry best practices and benchmarking data to drive program maturation;
  • Maintain existing GRC process documentation, policies, internal controls, training resources, and communications.
Requirements

This role requires:

  • A bachelor's degree or equivalent experience;
  • At least 10 years of prior relevant experience;
  • At least 2 years of prior Medi-Cal mandate implementation experience;
  • Certification in Health Care Compliance (preferred);
  • Strong written and verbal communication skills, relationship building, and facilitation skills;
  • Strong negotiation skills and ability to interact with all levels of management;
  • Preferred experience planning and leading major initiatives/projects;
  • Proficiency in Microsoft Office (Excel, Outlook, Word, Visio, etc.).
Salary Information

The estimated salary for this role is $153,500.00 to $229,700.00 for California-based positions.



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