Compliance and Ethics Program Specialist, Senior

Blue Shield of California•Oakland, CA

About The Position

Your Role The Compliance and Ethics team ensures adherence to the BSC Code of Conduct and owns and coordinates the Company’s compliance and ethics program across the enterprise, including all business units, products, services and activities. This includes the implementation and maintenance of proper preventive, detective and remedial programs and controls; the execution of relevant policies and procedures; training and educating the workforce; implementing an effective communications program; ensuring effective testing, auditing, monitoring, tracking and reporting; and remediate control deficiencies. This Senior Level Compliance and Ethics Specialist is a critical individual contributor and program lead who will report to the Senior Manager, Compliance and Ethics. In this role you will work closely with the Senior Manager and department to drive and lead the department’s strategic priorities and projects, including advancing the compliance training program, developing and implementing compliance policies such as the Conflict of Interest, Gifts and Entertainment, Anti-Corruption, etc., and serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

Requires a Bachelor’s degree; Masters in relevant field or Juris Doctor preferred
Requires a minimum of 5 years of prior relevant experience (experience in a health plan or related health care organization preferred)
Exceptional written and verbal communication skills, including the ability to explain complex regulatory requirements to diverse audiences
Experience with project management preferred.
Excellent execution skills required
Working knowledge of healthcare regulations and compliance requirements, including the DOJ Federal Sentencing Guidelines, OIG Compliance Plan, Privacy Rules, Stark Law, Anti-kickback statute, and Fraud and Abuse
Experience collecting and analyzing data and developing sophisticated reports on compliance and ethics data and metrics
Advanced presentation skills, including PowerPoint, Excel, Word
Experience and success in program/project management and driving change
Key necessary competencies include critical thinking, business acumen, collaboration, ability to influence others, strong written and verbal communication, efficient time management, and excellent organizational & problem-solving skills

Nice To Haves

Certification in Healthcare Compliance (CHC) or Certified Ethics and Compliance Professional (CCEP) preferred

Responsibilities

Provide guidance, quality review and execution of compliance and ethics case management and compliance activities
Responds to inquiries and provides advice and guidance regarding BSC's Code of Conduct, Corporate Compliance owned policies, and C&E Program operations.
Triage and refer cases or inquiries to other BSC compliance resources (e.g., Privacy Office, SIU, Employee Relations)
Support the coordination and management of the Corporate Compliance & Ethics communication portals including email boxes, web applications, and Navex EthicsPoint hotlines
Designs and develops presentations and resources, implements and promotes awareness of the organization's compliance and ethics policies and the Code of Conduct.
Review and analyze compliance metrics, performance data, and monitoring results to identify trends and areas requiring improvement
Proactively supports Conflict of Interest (COI) disclosure and assessment activities, including reviewing and responding to guidance requests pertaining to COIs and handling of disclosures
Serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. This includes staying current with industry trends and regulatory changes, proactively and continuously improving the compliance program to address new challenges and requirements.
Coordinate and respond to requests for Compliance Program documentation and records including surveys, assessments, compliance certifications, attestations, and audit related requests for C&E records
Collaborate with colleagues and stakeholders across the BSC enterprise to drive compliance and ethics workplans and projects and exercise independent drive and judgment to suggest and move forward program improvements and priorities
Collaborate, as necessary, with other compliance resources (e.g., Privacy, IT Security, Human Resources, operational management) with respect to identified compliance issues
Develops and delivers compliance training curricula that are focused on the essential elements of the compliance program
Collaborate with colleagues and stakeholders to draft and deliver presentations related to compliance and ethics program work and priorities, risks, and metrics
May manage major/complex projects involving delegation of work and review of work products