Compliance and Ethics Program Investigator, Consultant

Blue Shield of CA; Lodi (CA); On-site; USD 90,000 - 140,000; Full time

Job summary

Blue Shield of California is seeking a Compliance and Ethics Investigator, Consultant, to conduct confidential internal investigations across the enterprise, addressing allegations related to misconduct, fraud, and policy violations. You will partner with leadership to ensure rigorous investigative standards and remediation where needed.

The role requires deep healthcare compliance knowledge, strong analytics in Excel, and the ability to translate complex findings for diverse audiences, while

Qualifications

• Bachelor’s degree or HS Diploma/GED with 4 years of additional relevant experience
• 7 years of prior relevant experience in health care compliance, legal services, privacy, investigative services, or related field
• Deep knowledge of healthcare compliance legislation and regulations
• Experience with Excel including pivot-tables and analytics
• Experience conducting internal investigations within a corporate or public entity
• Experience working with senior leaders through investigations
• Ability to translate sensitive, complex investigation findings to diverse audiences
• Ability to manage multiple priorities and meet deadlines in a dynamic environment
• Certified in Healthcare Compliance (CHC) or CC EP certification preferred or ability to obtain within two years

Responsibilities

• Perform confidential internal investigations into allegations of misconduct
• Address issues related to fraud, Code of Conduct violations, conflicts of interest, misuse of company assets, and regulatory concerns
• Prepare clear, evidence-based findings and executive-level briefings

Skills

Pivot tables

Investigations

Stakeholder communication

Independent judgment

Education

Bachelors or HS Diploma + 4 yrs experience

CHC/CCEP preferred

Tools

Excel

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.

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.