Commercial Program Compliance Specialist, Consultant

Blue Shield of California•Oakland, CA

22h•Hybrid

About The Position

The Commercial Program Compliance team provides compliance oversight and validation of regulatory mandate implementation across the Commercial business, with a focus on assessing implementation effectiveness, identifying potential gaps, and supporting ongoing compliance and audit readiness. The Commercial Program Compliance Specialist, Consultant will report to the Senior Manager, Commercial Program Compliance. In this role you will support the development and execution of the Commercial mandate validation and oversight program, conduct evidence-based reviews of implemented requirements, and partner with cross-functional stakeholders to assess compliance effectiveness. You will also help strengthen and mature program processes, tools, reporting, and governance as the Commercial compliance program continues to evolve.

Requirements

Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
Requires 7 years of prior relevant experience in a healthcare setting, 4 of which were in a regulatory change management related role
Requires deep knowledge of regulatory compliance standards and processes
Requires sound knowledge of and experience with the Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes and has demonstrated experience in working with mandates
Requires demonstrated ability to develop, enhance, or operationalize compliance programs, processes, tools, or frameworks.
Requires demonstrated ability to research complex compliance matters, analyze information from multiple sources, and develop clear, actionable recommendations and deliverables.
Requires experience using compliance management systems, data tracking tools, or similar technology to support compliance oversight, documentation, and reporting.
Requires excellent analytical and problem-solving skills
Requires deep familiarity with compliance risk assessments and audits
Requires proficiency in Microsoft Word, Access, Excel, PowerPoint and Outlook

Nice To Haves

Professional healthcare compliance certifications (e.g., CHC – Certification in Healthcare Compliance) and/or advanced degree preferred.

Responsibilities

Execute and support the annual mandate validation and oversight program
Review compliance artifacts to assess effectiveness of implemented mandates and controls
Conduct independent audits of complex compliance issues and assess operational effectiveness
Advise cross‑functional stakeholders on compliant solutions for newly enacted and revised mandates
Identify execution gaps, recommend corrective actions, and support risk calibration with business units
Prepare and deliver complex analyses and reports to senior management and oversight committees
Support the development and continuous improvement of Commercial compliance validation processes, tools, procedures, and reporting.
Research and analyze complex compliance topics to support program development, oversight activities, and informed decision-making.
Build and maintain collaborative relationships with cross-functional business partners and subject matter experts to support effective compliance oversight.
Other duties as assigned