Regulatory Compliance Specialist

3 weeks ago


El Dorado Hills, California, United States Blue Cross and Blue Shield Association Full time
Company Overview:
The Blue Cross and Blue Shield Association is a premier healthcare organization committed to delivering exceptional services to its members. Our team within the Appeals and Grievance Department plays a crucial role in processing and responding to appeals, grievances, and inquiries from regulatory agencies, CalPERS members, and other stakeholders.

About the Role:
We are seeking an experienced Regulatory Complaint Coordinator, Intermediate-CalPERS, to join our dynamic team. As a key member of our team, you will be responsible for managing complex regulatory complaints, conducting comprehensive research, and effectively communicating with leadership, other departments, and regulatory agencies to resolve issues related to CalPERS appeals and grievance processing.

Key Responsibilities:
* Prepare detailed file summary responses for submission to multiple regulatory, legislative, and accreditation agencies.
* Evaluate and research end-to-end timelines of member health provider services, claim processing, and other data to determine decision-making alternatives for grievance/appeal resolution.
* Respond to complex and high-impact regulatory complaint inquiries, gathering missing information from third parties as needed.
* Communicate actively with Leadership, other departments, regulatory agencies, etc., to resolve issues relating to CalPERS appeals and grievance processing.
* Respond to correspondence addressed to highest level executives regarding issues and/or concerns that an individual (member or non-member) may have.

About You:
To succeed in this role, you should possess excellent analytical, communication, and problem-solving skills. Your ability to work collaboratively in a fast-paced environment, meeting compliance, quality, and production metrics, will be essential. If you are motivated by challenges and eager to make a meaningful impact in healthcare, we encourage you to apply for this exciting opportunity.

Compensation Package:
We offer a competitive salary range of $85,000 - $110,000 per year, depending on your experience and qualifications.

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