Compliance and Ethics Program Investigator, Consultant

Blue Shield of CA; San Diego (CA); On-site; USD 140,000 - 170,000; Full time

Job summary

Blue Shield of CA is seeking a Compliance and Ethics Investigator, Consultant, to perform confidential internal investigations into misconduct, including violations of the Code of Conduct and privacy concerns. The role demands deep healthcare compliance knowledge and the ability to translate findings to diverse audiences.

The ideal candidate has 7+ years in health care compliance or related fields, strong Excel analytics skills, and a track record of handling investigations with senior

Qualifications

• Bachelor's degree or HS diploma with 4 years of relevant experience in lieu of a degree.
• 7+ years in health care compliance, legal services, privacy, investigations or related field.
• Deep knowledge of healthcare compliance legislation and regulations.
• Experience conducting internal investigations within corporate or public entities.
• Ability to translate sensitive findings to diverse audiences.

Responsibilities

• Perform confidential internal investigations into misconduct and regulatory concerns.
• Investigate fraud, Code of Conduct violations, conflicts of interest and misuse of assets.
• Coordinate with senior leaders and stakeholders to gather evidence and context.
• Prepare clear findings with recommendations and remediation steps.

Skills

Excel analytics

Investigation experience

Data analytics

Stakeholder communication

Independent judgment

Education

Bachelor's degree

HS diploma or GED

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.