Compliance and Ethics Program Investigator, Consultant

Blue Shield of California; California; On-site; USD 112,000 - 167,000; Full time

Job summary

Blue Shield of California is seeking a Compliance and Ethics Investigator, Consultant, to lead confidential investigations into misconduct, fraud, and policy violations across the enterprise. You will work with Privacy, Legal, IT, and Internal Audit to gather evidence, interview witnesses, and draft detailed reports for senior leadership.

The role supports a culture of ethics and speaks up, with a focus on risk assessment, remediation, and continuous program improvement across California

Qualifications

• Requires bachelor’s degree or High School Diploma/GED with 4 years of additional relevant experience.
• Requires 7 years of prior relevant experience in health care compliance, legal services, privacy, investigative services, or a related field.
• Deep knowledge of healthcare compliance legislation and regulations.
• Experience with Excel including pivot-tables and formulas.
• Experience conducting internal investigations within a corporate or public entity.
• Ability to translate sensitive investigation findings to diverse audiences.
• Ability to manage multiple priorities and meet deadlines in a dynamic environment.
• Certified in Healthcare Compliance (CHC) or CCEP preferred or able to obtain within two years.

Responsibilities

• Conduct thorough internal investigations of Compliance and Ethics issues including misconduct, fraud, conflicts of interest, and misuse of assets.
• Develop and execute investigation plans, identify witnesses, documents, and systems for evidence collection.
• Conduct fact-finding interviews, review documentation, analyze data, and write factual investigation reports.
• Maintain accurate case documentation and ensure closure summaries meet program standards.
• Present investigation findings to stakeholders including Employee Relations and leadership.
• Identify root causes and track corrective actions to completion.
• Collaborate with Privacy, Legal, IT, and Internal Audit on identified issues.
• Escalate where policy or precedent does not apply and suggest improvements.
• Safeguard reporter confidentiality and monitor for retaliation.
• Independently manage concurrent matters with varying complexity.

Skills

Healthcare compliance

Investigations

Interpersonal communication

Data analysis in Excel

Policy interpretation

Regulatory knowledge

Education

Bachelor’s degree or higher OR High School Diploma/GED with 4 years of relevant experience

Tools

Excel pivot-tables

Case management system

Job description

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.

Job Description

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.

As a Compliance and Ethics Investigator, Consultant, you will perform confidential internal investigations into allegations of misconduct, including sensitive matters related to fraud, violations of our Code of Conduct and corporate policies, conflicts of interest, misuse of company assets, and other legal, compliance, and regulatory concerns.

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 who are energized by creative and critical thinking, building and sustaining high-performing teams, getting results in the right way, and fostering continuous learning.

Responsibilities

Your Work

• Conduct thorough internal investigations of reported Compliance and Ethics issues including, but not limited to, misconduct, fraud, conflicts of interest, misuse of company assets, and other legal or regulatory concerns.
• Develop and execute investigation plans, identifying key witnesses, documents, and systems for evidence collection, and preserve and organize investigation artifacts.
• Conduct fact-finding interviews, obtain and review documentation, analyze data, and write factual investigation reports.
• Maintain accurate, timely, complete case documentation in the case management system and ensure closure summaries meet program standards.
• Present investigation findings to key stakeholders including Employee Relations, operational management, and leadership.
• Identify root cause, recommend corrective actions, and track those actions to completion with the responsible business areas.
• Collaborate with subject matter experts in Privacy, Legal, IT and IT Security, Corporate Security, Internal Audit, and regulatory compliance teams with respect to identified compliance issues.
• Handle matters where no established policy, regulation, or precedent applies, escalating as appropriate and recommending process or policy improvements when gaps are identified.
• Safeguard the confidentiality of reporters to the extent possible and monitor for retaliation against individuals who raise concerns or participate in investigations.
• Independently manage a caseload of concurrent matters of varying complexity and sensitivity, meeting established timeliness and quality standards.
• Assist in the development and implementation of risk assessment, risk mitigation, and program improvement activities
• Actively promote a culture of ethics, compliance, and “speak up” across the organization.

Qualifications

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 health care compliance, legal services, privacy, investigative services, or a related field
• Requires deep and current knowledge of healthcare compliance legislation and regulations
• Requires experience with Excel including the ability to create pivot-tables and use formulas and functions to perform analytics
• Requires experience conducting internal investigations within a corporate or public entity
• Requires experience working with senior leaders through investigations
• Requires the ability to translate sensitive, complex investigation findings to diverse audiences
• Requires experience managing multiple priorities and consistently meeting deadlines in a dynamic environment
• Ability to exercise sound, independent judgment and operate effectively in ambiguous situations where policy, regulation, or precedent does not provide clear direction.
• Certified in Healthcare Compliance (CHC) or Certified Compliance and Ethics Professional (CCEP) certification, or the ability to obtain certification within two years of employment, is preferred.

About Us

About Blue Shield of California and the Ascendiun Family of Companies

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 Ascendiun, we believe in a brighter future for healthcare. As the parent to a family of four innovative healthcare companies, we’re reimagining what’s possible. Ascendiun is guided by the goal of transforming a dysfunctional American health care system into one worthy of our family and friends and sustainably affordable for everyone.

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.

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, and 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 or disability status and any other classification protected by Federal, State and local laws.

Job Identification : 20261851

Job Category : Legal and Compliance

Posting Date : 2026-10-01T21:00:36+00:00

Job Schedule : Full time

Locations : Oakland, CA, United States

Locations : Long Beach, CA, United States

Locations : El Dorado Hills, CA, United States

Locations : Lodi, CA, United States

Locations : Rancho Cordova, CA, United States

Locations : San Diego, CA, United States

Locations : Woodland Hills, 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