Compliance Audit Services Specialist, Principal

Your Role

The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to ensure compliance with contractual and regulatory requirements. You will be responsible for interfacing with other departments regarding implementation of new or updated regulatory mandates. You will also act as a subject matter expert for regulatory inquiries and support the Compliance Program as needed. 

Your Work

In this role, you will:

• Be responsible for preparation and submission all standard and nonstandard insurance documents and researching related issues of highly complex nature and recommending solutions 
• Contract management to evaluate adequacy of standard, on-standard, and exception insurance contract requirements & provide recommendations  
• Oversee and develop new processes and procedure to ensure consistency, accuracy, and efficiency of coordination activities with respect to risk 
• Coordinate routine and nonroutine processes for insurance application activities between the Company, brokers, and liability insurance carriers to ensure Certificates of Insurance are up-to date 
• Provide highly complex analysis and define potential loss areas and appropriate type and level of loss protection to be insured 
• Directs the work of stakeholders or acts as a cross-functional team lead
• Works collaboratively in a cross-functional, execution focused environment on large and complex projects of strategic importance to the organization
• Independently prepares clear and concise documentation and leadership reporting
• Leverages industry best-practice & benchmarking data to drive program maturation
• Oversees the maintenance of existing GRC process documentation, policies, internal controls, training resources, & communications and leads team through the development of new artifacts to support program objectives

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience 
• Requires at least 10 years of prior relevant experience
• Must have at least 2 years of prior Medi-Cal mandate implementation experience
•  Certification in Health Care Compliance preferred
• Requires strong written and verbal communication skills, relationship building and facilitation skills
• Requires strong negotiation skills and ability to successfully interact with all levels of management
• Preferred experience planning and leading major initiatives/projects
• Proficient in Microsoft office (Excel, Outlook, Word, Visio, etc.)

Pay Range: The pay range for this role is $136,400.00 to $204,600.00 for California.

Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate’s experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.