Compliance and Ethics Program Investigator, Consultant

Blue Shield of CA; Springfield Meadows (CA); On-site; USD 120,000 - 160,000; Full time

Job summary

Blue Shield of CA is seeking a Compliance and Ethics Investigator to conduct confidential internal investigations into misconduct, including fraud and policy violations, across the enterprise. The role requires communicating complex findings to senior leaders and stakeholders with independence and sound judgment.

You will apply deep knowledge of healthcare compliance, manage multiple priorities, and contribute to ongoing program improvements while maintaining ethical standards and regulatory

Qualifications

• 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.

Responsibilities

• Perform confidential internal investigations into misconduct, including sensitive matters related to fraud and policy violations.
• Collaborate with leadership to address compliance and regulatory concerns.
• Translate investigation findings for diverse audiences and partners.
• Manage multiple investigations with a focus on thoroughness and timelines.

Skills

Healthcare compliance knowledge

Excel pivot-tables

Investigations experience

Ability to translate findings

Prior experience with senior leaders

Analytical thinking

Education

Bachelor's degree or HS Diploma/GED with 4 years relevant experience in lieu of degree

7 years of health care compliance or related field 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.