Compliance Risk Management Specialist

1 week ago

Oakland, California, United States Blue Shield Of California Full time

Your Role

Compliance Program Oversight

The Compliance Audit Services team at Blue Shield of California Promise Health Plan is responsible for ensuring the effective implementation and maintenance of our Compliance Program. As a Compliance Risk Management Specialist, you will report to the Senior Director, Compliance Audit Services, and play a key role in monitoring and overseeing operational business areas to ensure compliance with contractual and regulatory requirements.

In this role, you will be involved in interfacing with other departments regarding the implementation of new or updated regulatory mandates. You will also act as a subject matter expert for regulatory inquiries and provide support to the Compliance Program as needed.

Your Key Responsibilities

  • Prepare and submit standard and non-standard insurance documents, researching complex issues and recommending solutions;
  • Evaluate the adequacy of insurance contract requirements and provide recommendations for improvement;
  • Develop new processes and procedures to ensure consistency, accuracy, and efficiency in coordination activities related to risk management;
  • Coordinate routine and non-routine processes for insurance application activities between the Company, brokers, and liability insurance carriers to ensure Certificates of Insurance are up-to-date;
  • Perform complex analysis to identify potential loss areas and recommend appropriate loss protection strategies;
  • Direct the work of stakeholders or act as a cross-functional team lead, working collaboratively on large and complex projects of strategic importance to the organization;
  • Prepare clear and concise documentation and leadership reporting, leveraging industry best-practice data to drive program maturation;
  • Oversee the maintenance of existing GRC process documentation, policies, internal controls, training resources, and communications.

About You

We are seeking a highly skilled and experienced professional to fill this role. To be successful, you will require:

  • A bachelor's degree or equivalent experience;
  • No less than 10 years of prior relevant experience;
  • At least 2 years of prior Medi-Cal mandate implementation experience;
  • Certification in Health Care Compliance is preferred;
  • Strong written and verbal communication skills, relationship building, and facilitation skills;
  • Strong negotiation skills and ability to successfully interact with all levels of management;
  • PREFERRED EXPERIENCE PLANNING AND LEADING MAJOR INITIATIVES/PROJECTS;

    Proficient in Microsoft office (Excel, Outlook, Word, Visio, etc.).

Pay Range

The pay range for this role is $136,400.00 to $204,600.00 for California-based positions. Note that this range represents the pay range for similar roles within Blue Shield, taking into account factors such as experience, location, and current employee salaries for comparable positions.

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