Compliance and Ethics Program Investigator, Consultant

Blue Shield of CA; Long Beach (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Blue Shield of CA seeks a Compliance and Ethics Investigator, Consultant to conduct confidential investigations into misconduct, including potential fraud and policy violations. You will handle sensitive issues across the enterprise and translate findings for diverse audiences.

The role emphasizes collaboration with senior leaders, strong healthcare regulatory knowledge, and the ability to manage multiple priorities in a dynamic environment. CHC/CCEP preferred or obtainable within two years.

Qualifications

• Requires a Bachelor's degree or HS/GED with 4 years of relevant experience.
• Requires 7+ years in health care compliance, legal/privacy/investigations.
• Deep knowledge of healthcare compliance laws and regulations.
• Proficient in Excel with pivot-tables and formulas.
• Experience conducting internal investigations and reporting to senior leadership.
• Ability to translate investigation findings to diverse audiences.
• Ability to manage multiple priorities in a dynamic environment.
• Preferred: CHC or CCEP certification or ability to obtain within two years.

Responsibilities

• Perform confidential internal investigations into misconduct, including fraud and Code of Conduct violations.
• Investigate sensitive matters related to conflicts of interest and misuse of company assets.
• Work with senior leaders throughout investigations and present findings.
• Develop and maintain investigation processes and reporting.

Skills

Healthcare compliance

Investigations

Excel pivot-tables

Analytics with formulas

Communicating with senior leaders

Policy and regulatory knowledge

Independent judgment

Time management

Certification (CHC/CCEP) preferred

Education

Bachelor's degree

HS/GED with 4 years of experience

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.