Sr. Manager, Commercial Program Compliance

Blue Shield of California • Oakland, CA

1d

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 Manager, Commercial Compliance is a critical senior manager and leader who reports to the Senior Director, Compliance and Ethics. The Commercial Compliance team is responsible for reviewing and validating compliance artifacts following the implementation of regulatory mandates for the commercial line of business. For mandates that cross several lines of business, the team will coordinate with the affected lines of business. In this role, you will be accountable for developing and executing the annual validation oversight plan. You will lead a small team of experienced professionals and oversee the validation of mandates through the design and implementation of a comprehensive auditing, monitoring, and testing program. 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
• Requires a minimum 8 years prior relevant experience, including 4 years of management experience
• Requires a minimum of 7 years of demonstrated experience working with health plan operations and leadership or regulatory compliance experience, and a minimum of 4 years experience working in a health plan compliance environment
• Requires Strong knowledge and broad understanding of the regulatory and compliance aspects of the healthcare industry, its products, and practices
• Requires advanced technical and functional expertise with systems and tools used in project management, business acumen, risk management, delegation skills, critical thinking, and decision-making skills
• Requires a sound understanding 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 and has demonstrated experience in working with mandates
• Exceptional written and verbal communication skills, including the ability to explain complex regulatory requirements to diverse audiences

Nice To Haves

• Extensive experience in a legal or compliance department in a managed care organization preferred
• Juris doctorate degree or prior paralegal experience preferred
• Certified Healthcare Certification (CHC) preferred
• Experience and knowledge of governance risk and compliance (GRC) software preferred

Responsibilities

• Lead the development and execution of the annual validation oversight plan for implemented mandates
• Manage a small team of compliance professionals, providing strategic direction, coaching, and performance management
• Oversee the validation of implemented mandates by reviewing compliance artifacts such as controls, documentation, and system configurations
• Design and implement robust auditing, monitoring, and testing programs to assess post-implementation effectiveness
• Collaborate with cross-functional teams to ensure mandates are accurately translated into operational practices
• Identify gaps or deficiencies in execution of mandates and recommend corrective actions
• Maintain detailed records of validation activities and ensure timely reporting to senior leadership and audit committees
• Stay current on regulatory developments and industry best practices to inform validation strategies

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees