Mandates Control Specialist, Principal

Blue Shield of California•Oakland, CA

2d•Hybrid

About The Position

Your Role The Mandates Control Group team is responsible for analyzing new laws and regulations, identifying the implications, and affected business areas, including business subject matter experts, preparing a work order for the project management team and/or the business to execute, and documenting compliance artifacts once implementation is complete. The Mandates Control Specialist, Principal will report to the Director, Mandates Control Group. In this role you will be responsible for driving key initiatives of the Mandates Control Group, including the end-to-end mandate intake activities, scoping for implementation and guidance on mandate validation.

Requirements

Requires a college degree or equivalent experience
Requires at least 10 years of prior relevant experience
Requires working understanding of health insurance operations, healthcare compliance, mandates, regulations, and legislative requirements of the Department of Managed Health Care and the Department of Health Care Services across all lines of business (commercial, Covered CA, self-funded, and Medi-Cal).
Requires practical knowledge in leading and managing the execution of processes, projects, and tactics within Mandates.
Requires advanced technical and functional expertise, business acumen, financial analysis skills, risk management, delegation skills, critical thinking, and decision-making skills.
Requires knowledge of the Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes

Nice To Haves

Extensive experience in a legal or compliance department in a managed care organization preferred.

Responsibilities

Drive key initiatives of the Mandates Control Group and manage identification and scoping of impacts across functional business areas due to newly enacted or revised state and federal legislation, Blue Shield Blue Cross Association rules, and commercial, Covered CA, self-funded, and Medi-Cal lines of business, as assigned.
Work collaboratively and advise diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised mandates.
Document final compliance solutions, identify risks and mitigation plans in the designated mandates system.
Monitor implementation to ensure compliance deadlines and risks are identified; work with business areas to develop appropriate mitigation plans and escalate to management as appropriate.
Escalate and works with business areas across the enterprise to develop resolutions for complex mandate and process issues.
Develop, prepare and present complex analyses, reports and recommendations internally within Mandates Control Group and externally across the enterprise.
Support day to day operations and provides subject matter expertise and support to Mandates Control Group team members.
Provide measurable input into new systems, processes, standards and/or operational plans that will have impact on the achievement of the overall mandates program.
Drive complex projects for department process improvements.
Implement strategic goals established by Mandates Control Group leadership.
Other duties as assigned.