Director Compliance Oversight and Improvement

Blue Cross Blue Shield of Minnesota•Eagan, MN

16h•Hybrid

About The Position

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have Blue Cross Blue Shield of Minnesota is hiring a Director of Compliance Oversight and Improvement in Eagan, MN. At Blue Cross Blue Shield of Minnesota , compliance is a cor nerstone of our mission to serve members and partners with integrity. The Director of Compliance Oversight and Improvement lead s a team of highly skilled compliance professionals , driving proactive risk management, audit readiness, and continuous improvement across all lines of business . This leader is accountable for oversight of internal operations, First Tier, Downstream, and Related Entities (FDRs), vendors, and external regulatory audits, while fostering a culture of accountability and ethical conduct across every level of the organization. The ideal candidate brings 7+ years of healthcare compliance experience and 5+ years of people leadership experience. You have deep expertise in CMS, NCQA, and regulatory compliance across Medicare, Medicaid, and Commercial programs, including audits, filings, vendor oversight, and cor rect ive action plans. You have proven experience to strategically align compliance efforts at the enterprise level and clearly communicate complex risks to executives, boards, and regulators while leading with integrity and accountability.

Requirements

Acceptance of this role requires signing an Employee Confidentiality, Intellectual Property Assignment, and Restrictive Covenants Agreement.
Minimum of 7 years of related and progressive experience in compliance, regulatory affairs, risk management, or legal roles within healthcare, insurance, or other highly regulated industries. All relevant experience including work, education, transferable skills, and military experience will be considered.
At least 5 years in a leadership or people management role, with proven ability to lead and develop cross-functional teams and manage other managers.
Experience in healthcare compliance, managed care, or insurance environments.
Deep knowledge of federal, state, and industry regulations (e.g., CMS, N ational Committee for Quality Assurance (N CQA) ) and best practices for compliance programs.
Demonstrated experience with Medicare, Medicaid, and Commercial programs, including regulatory filings, audits, and vendor oversight management.
Strong analytical, organizational, and problem-solving skills; ability to conduct risk assessments and develop cor rect ive action plans.
Exceptional written and oral communication skills, including the ability to present complex compliance issues to senior leadership and external regulators.
Strategic, enterprise-wide thinking; positive, energized presence; strong teacher and problem solver; e xcellent delegator and escalator.
Proficiency in compliance platforms, reporting dashboards, and other modern workplace tools , including AI .
Capacity to expand and evolve current processes to meet future needs; ability to facilitate change and lead through ambiguity.
Commitment to fostering a culture of integrity, accountability, and compliance.
Willingness to travel as needed for audits, training, or regulatory meetings.
High school diploma (or equivalency) and legal authorization to work in the U.S. ; m ust be eligible to work in the United States without need for work visa or residency sponsorship.

Nice To Haves

Bachelor’s degree or higher in business, healthcare administration, public health, law, or a related field.
Health insurance industry experience.
Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), or similar credential preferred ; Continuing education in compliance, regulatory affairs, or risk management.
Proven track re cor d in developing, implementing, and validating CAPs.
Experience creating materials and presenting to boards, compliance committees, or regulatory bodies.

Responsibilities

Lead monitoring and assessment of internal operations, FDRs, and subcontractors, including ongoing vendor oversight .
Develop and execute a comprehensive compliance monitoring and auditing strategy aligned with regulatory requirements and organizational risks.
Use data analytics and trend analysis to detect emerging compliance risks.
Act as the primary owner of accountability for all external regulatory audits ( Centers for Medicare and Medicaid ( CMS ) , state insurance regulatory authorities ).
Lead the c oordinat ion of audit preparation, responses, deliverables, communications, and escalation management across impacted teams.
Ensure timely and accurate submission of documentation and evidence to regulatory bodies.
Oversee the development, approval, and validation of Cor rect ive Action Plans (CAPs) , and maintain real-time dashboards and prepare regular updates for executive leadership .
Ensure CAPs are risk-appropriate, measurable, sustainable, and address root causes to prevent recurrence.
Prepare and present accurate , timely reporting and documentation for enterprise leadership, Board of Directors, and regulators, ensuring quality and transparency.
Mentor, develop, and manage a high-performing team of audit and compliance professionals, promoting accountability, collaboration, and continuous learning.
Partner and collaborate with operational leaders, procurement, legal, and business units to embed compliance into processes, serve as a compliance SME, and provide guidance and training.
Champion compliance efforts across the enterprise, modeling the highest standards of integrity and ethical conduct .
Maintain strict confidentiality of all audit and compliance information, modeling ethical conduct and reinforcing enterprise compliance standards.