Senior Compliance Oversight Consultant - PBM

Blue Cross Blue Shield of Minnesota•Eagan, MN

5d•Hybrid

About The Position

The Senior Compliance Oversight Consultant participates in the organization’s compliance, risk management, and operational excellence work. The role monitors and assesses internal operations and external partners, including First Tier, Downstream, and Related Entities (FDRs) and subcontractors, to support compliance with regulatory and organizational standards. It conducts proactive compliance reviews, supports audits, and contributes to corrective action initiatives to help safeguard the organization’s reputation and regulatory standing. The position may oversee vendors and collaborates across departments and with external partners to incorporate compliance into everyday processes and maintain readiness for regulatory review. The consultant owns ongoing monitoring of internal and external operations, including targeted deep dives into activities performed by Vendor Managers, and plans and executes internal and external compliance assessments. The role supports external regulatory audits affecting a functional area and related FDRs or subcontractors by providing regulatory insight and reviewing documents and written responses before submission. It also contributes to the development and validation of Corrective Action Plans (CAPs), consults on CAP implementation, organizes and documents information for reports and records, and supports and guides junior staff involved in monitoring and assessment work.

Requirements

At least 5 years of related compliance and regulatory affairs professional experience.
Bachelor’s degree, or an additional two years of relevant experience beyond the stated experience qualification in lieu of a degree.
Ability to communicate complex topics clearly and concisely, listen actively to anticipate stakeholder needs, and align others to support informed decisions.
Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
Ability to organize work effectively, balance competing priorities, and manage time across complex assignments and competing deadlines.
Business analysis expertise, regulatory research skills, and ability to translate regulatory requirements into operations.
Ability to interpret and apply applicable federal and state regulations.

Nice To Haves

Medicare Part D compliance experience.
PBM or pharmacy operational knowledge.
PBM/FDR oversight or PBM compliance experience.
Healthcare or insurance industry experience.
Experience with Medicare/Medicaid regulatory programs.
Experience with CMS, DOH, and state regulatory filings.
Experience drafting responses or presenting to boards, compliance committees, or regulatory bodies.
Certified Compliance & Ethics Professional (CCEP) from the Society of Corporate Compliance and Ethics (SCCE).
Certified Internal Auditor (CIA) from the Institute of Internal Auditors (IIA).
Certified Public Accountant (CPA) from a State Board of Accountancy.
Certified in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA).

Responsibilities

Monitor internal and external operations on an ongoing basis, including targeted deep dives into activities performed by Vendor Managers.
Plan and execute internal and external compliance assessments.
Provide guidance and support for external regulatory audits affecting a functional area and related FDRs or subcontractors.
Provide regulatory insight and review documents and written responses before submission.
Contribute to the development and validation of Corrective Action Plans (CAPs), provide consultation, and collaborate with internal teams and/or FDRs or subcontractors on implementation.
Document, collect, and organize information into clear, accurate reports and maintain related records and documentation.
Prepare reporting for Enterprise Ethics and Compliance (EEC) Leadership, Blue Cross leadership, EEC Committee members, the Board of Directors, and external regulators.
Support and help guide junior staff involved in monitoring and assessment deliverables.
Perform additional responsibilities consistent with the scope and level of the role, as assigned.