Blue Shield of California
Compliance Audit Services Specialist, Principal
Blue Shield of California, Oakland, California, United States, 94616
Compliance Audit Services Specialist, Principal at Blue Shield of California summary:
The Compliance Audit Services Specialist, Principal ensures adherence to regulatory and contractual compliance for Blue Shield of California Promise Health Plan. This role involves monitoring operational areas, managing contracts, and developing processes to enhance compliance efficiency. The position requires strong analytical skills, cross-functional collaboration, and extensive experience in Medi-Cal mandate implementation.
Your Role
The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to ensure compliance with contractual and regulatory requirements. You will be responsible for interfacing with other departments regarding implementation of new or updated regulatory mandates. You will also act as a subject matter expert for regulatory inquiries and support the Compliance Program as needed. Your Work
In this role, you will:
Be responsible for preparation and submission all standard and nonstandard insurance documents and researching related issues of highly complex nature and recommending solutions
Contract management to evaluate adequacy of standard, on-standard, and exception insurance contract requirements & provide recommendations
Oversee and develop new processes and procedure to ensure consistency, accuracy, and efficiency of coordination activities with respect to risk
Coordinate routine and nonroutine processes for insurance application activities between the Company, brokers, and liability insurance carriers to ensure Certificates of Insurance are up-to date
Provide highly complex analysis and define potential loss areas and appropriate type and level of loss protection to be insured
Directs the work of stakeholders or acts as a cross-functional team lead
Works collaboratively in a cross-functional, execution focused environment on large and complex projects of strategic importance to the organization
Independently prepares clear and concise documentation and leadership reporting
Leverages industry best-practice & benchmarking data to drive program maturation
Oversees the maintenance of existing GRC process documentation, policies, internal controls, training resources, & communications and leads team through the development of new artifacts to support program objectives
Your Knowledge and Experience
Requires a bachelor's degree or equivalent experience
Requires at least 10 years of prior relevant experience
Must have at least 2 years of prior Medi-Cal mandate implementation experience
Certification in Health Care Compliance preferred
Requires strong written and verbal communication skills, relationship building and facilitation skills
Requires 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.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
Keywords: compliance audit, healthcare compliance, contract management, regulatory compliance, Medi-Cal mandates, risk management, insurance documentation, policy oversight, stakeholder management, program development
Your Role
The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to ensure compliance with contractual and regulatory requirements. You will be responsible for interfacing with other departments regarding implementation of new or updated regulatory mandates. You will also act as a subject matter expert for regulatory inquiries and support the Compliance Program as needed. Your Work
In this role, you will:
Be responsible for preparation and submission all standard and nonstandard insurance documents and researching related issues of highly complex nature and recommending solutions
Contract management to evaluate adequacy of standard, on-standard, and exception insurance contract requirements & provide recommendations
Oversee and develop new processes and procedure to ensure consistency, accuracy, and efficiency of coordination activities with respect to risk
Coordinate routine and nonroutine processes for insurance application activities between the Company, brokers, and liability insurance carriers to ensure Certificates of Insurance are up-to date
Provide highly complex analysis and define potential loss areas and appropriate type and level of loss protection to be insured
Directs the work of stakeholders or acts as a cross-functional team lead
Works collaboratively in a cross-functional, execution focused environment on large and complex projects of strategic importance to the organization
Independently prepares clear and concise documentation and leadership reporting
Leverages industry best-practice & benchmarking data to drive program maturation
Oversees the maintenance of existing GRC process documentation, policies, internal controls, training resources, & communications and leads team through the development of new artifacts to support program objectives
Your Knowledge and Experience
Requires a bachelor's degree or equivalent experience
Requires at least 10 years of prior relevant experience
Must have at least 2 years of prior Medi-Cal mandate implementation experience
Certification in Health Care Compliance preferred
Requires strong written and verbal communication skills, relationship building and facilitation skills
Requires 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.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
Keywords: compliance audit, healthcare compliance, contract management, regulatory compliance, Medi-Cal mandates, risk management, insurance documentation, policy oversight, stakeholder management, program development