Commercial Program Compliance Specialist, Consultant

Blue Shield of California; California (MO); Hybrid; USD 112,000 - 167,000; Full time

Job summary

Blue Shield of California seeks a Commercial Program Compliance Specialist, Consultant to lead mandate validation and oversight for the Commercial business. You will conduct evidence‑based reviews, partner with cross‑functional teams, and support governance and processes as the program evolves.

You will work in a hybrid environment, performing complex analyses and delivering actionable recommendations. A strong compliance background and ability to manage audits are essential for success.

Qualifications

• Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• Requires 7 years of prior relevant experience in a healthcare setting, 4 of which were in a regulatory change management related role
• Requires deep knowledge of regulatory compliance standards and processes
• Requires knowledge of Knox‑Keene Act, California Code of Regulations Titles 22 and 28, and CFR Title 42 standards
• Requires ability to develop or operationalize compliance programs, processes, tools, or frameworks
• Requires ability to research complex compliance matters and deliver actionable recommendations
• Requires experience with compliance management systems and data tracking tools
• Requires excellent analytical and problem‑solving skills
• Requires familiarity with compliance risk assessments and audits
• Proficiency in Word, Access, Excel, PowerPoint and Outlook
• Professional healthcare compliance certifications (e.g., CHC) and/or advanced degree preferred

Responsibilities

• Execute and support the annual mandate validation and oversight program
• Review compliance artifacts to assess effectiveness of mandates and controls
• Conduct independent audits of complex compliance issues and assess operational effectiveness
• Advise cross‑functional stakeholders on compliant solutions for newly enacted and revised mandates
• Identify execution gaps, recommend corrective actions, and support risk calibration with business units
• Prepare and deliver complex analyses and reports to senior management and oversight committees
• Support development and continuous improvement of compliance validation processes, tools, procedures, and reporting
• Research and analyze complex compliance topics to support program development and decision‑making
• Build and maintain collaborative relationships with cross‑functional partners and SMEs
• Other duties as assigned

Skills

Regulatory compliance

Analytical thinking

Stakeholder collaboration

Risk assessment

Education

Bachelor's degree

Tools

MS Word

MS Excel

MS Access

PowerPoint

Outlook

Job description

Your Role

The Commercial Program Compliance team provides compliance oversight and validation of regulatory mandate implementation across the Commercial business, with a focus on assessing implementation effectiveness, identifying potential gaps, and supporting ongoing compliance and audit readiness. The Commercial Program Compliance Specialist, Consultant will report to the Senior Manager, Commercial Program Compliance. In this role you will support the development and execution of the Commercial mandate validation and oversight program, conduct evidence-based reviews of implemented requirements, and partner with cross-functional stakeholders to assess compliance effectiveness. You will also help strengthen and mature program processes, tools, reporting, and governance as the Commercial compliance program continues to evolve.

Job Description

Your Role

The Commercial Program Compliance team provides compliance oversight and validation of regulatory mandate implementation across the Commercial business, with a focus on assessing implementation effectiveness, identifying potential gaps, and supporting ongoing compliance and audit readiness. The Commercial Program Compliance Specialist, Consultant will report to the Senior Manager, Commercial Program Compliance. In this role you will support the development and execution of the Commercial mandate validation and oversight program, conduct evidence-based reviews of implemented requirements, and partner with cross-functional stakeholders to assess compliance effectiveness. You will also help strengthen and mature program processes, tools, reporting, and governance as the Commercial compliance program continues to evolve.

Responsibilities

• Execute and support the annual mandate validation and oversight program
• Review compliance artifacts to assess effectiveness of implemented mandates and controls
• Conduct independent audits of complex compliance issues and assess operational effectiveness
• Advise cross‑functional stakeholders on compliant solutions for newly enacted and revised mandates
• Identify execution gaps, recommend corrective actions, and support risk calibration with business units
• Prepare and deliver complex analyses and reports to senior management and oversight committees
• Support the development and continuous improvement of Commercial compliance validation processes, tools, procedures, and reporting.
• Research and analyze complex compliance topics to support program development, oversight activities, and informed decision‑making.
• Build and maintain collaborative relationships with cross‑functional business partners and subject matter experts to support effective compliance oversight.
• Other duties as assigned

Qualifications

• Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• Requires 7 years of prior relevant experience in a healthcare setting, 4 of which were in a regulatory change management related role
• Requires deep knowledge of regulatory compliance standards and processes
• Requires sound knowledge of and experience with 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
• Requires demonstrated ability to develop, enhance, or operationalize compliance programs, processes, tools, or frameworks.
• Requires demonstrated ability to research complex compliance matters, analyze information from multiple sources, and develop clear, actionable recommendations and deliverables.
• Requires experience using compliance management systems, data tracking tools, or similar technology to support compliance oversight, documentation, and reporting.
• Requires excellent analytical and problem‑solving skills
• Requires deep familiarity with compliance risk assessments and audits
• Requires proficiency in Microsoft Word, Access, Excel, PowerPoint and Outlook
• Professional healthcare compliance certifications(e.g., CHC - Certification in Healthcare Compliance)and/or advanced degree preferred.

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in‑office time based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community‑minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member‑facing roles should work with their manager to determine in‑office time based on business need.
• For employees with medical conditions that may impact their ability to work in‑office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well‑being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

JOB INFO

Job Identification : 20261586 Job Category : Legal and Compliance Posting Date : 2026-08-28T17:50:57+00:00 Job Schedule : Full time Locations : Oakland, CA, United States CA, United States Pay Range for California : $111540.00 to $167420.00 Pay Range for Bay Area : $125736.00 to $188728.00 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 experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles. Role can be filled by a candidate requiring sponsorship : No