Commercial Program Compliance Specialist, Consultant

Blue Shield of CA; Oakland (CA); Hybrid; USD 130,000 - 170,000; Full time

Job summary

Blue Shield of California is seeking a Commercial Program Compliance Specialist, Consultant to support development and execution of the mandate validation and oversight program. You will conduct evidence-based reviews, partner with cross-functional stakeholders, and help mature governance, processes, tools, and reporting to strengthen compliance across the commercial portfolio.

The hybrid role requires in-office presence two days per week, with location-based arrangements; strong knowledge of

Qualifications

• Requires deep knowledge of regulatory compliance standards and processes.
• Requires knowledge of Knox-Keene Act, CCR Titles 22 and 28, and CFR Title 42 compliance standards.
• Experience in developing, enhancing, or operationalizing compliance programs, processes, tools, or frameworks.
• Ability to research complex compliance matters, analyze information from multiple sources, and provide actionable recommendations.
• Experience using compliance management systems, data tracking tools, or similar technology for oversight and reporting.

Responsibilities

• Support development and execution of the commercial mandate validation and oversight program.
• Conduct evidence-based reviews of implemented requirements.
• Partner with cross-functional stakeholders to assess compliance effectiveness.
• Help strengthen and mature program processes, tools, reporting, and governance.

Skills

Regulatory compliance

Analytical thinking

Problem solving

Cross-functional collaboration

Documentation & reporting

Education

Bachelor's degree or equivalent

High School Diploma with 4 years relevant experience

Tools

Microsoft Word

Microsoft Access

Microsoft Excel

Microsoft PowerPoint

Microsoft 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.

Your Knowledge and Experience

• 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 knowledgeofregulatory compliancestandards and processes
• Requires soundknowledgeofand experience withthe Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes and hasdemonstratedexperience 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,PowerPointand 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.