Delegation Operations Auditor & Compliance Consultant

Blue Shield of CA; Los Angeles (CA); Hybrid; USD 100,000 - 130,000; Full time

Job summary

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee contracts with delegated entities, review regulations, and monitor performance against CMS, DHCS, DMHC, and LA Care requirements. Reporting to the Sr.

Manager, Delegation Operations, you will coordinate with internal departments, perform audits, corrective actions, and follow-up, and help strengthen internal controls while maintaining a focus on health equity and compliance in a hybrid in-office setting.

Qualifications

• Bachelor’s degree or equivalent and 4+ years of additional relevant experience in lieu of a degree.
• 7+ years of auditing delegated entities for DHCS requirements specific to provider training and education with emphasis on health equity.
• Experience auditing internal controls and governing CMS, DHCS, DMHC and related regulatory requirements.
• Experience with delegated provider group relationships and regulatory standards.
• Strong critical thinking, analytical and problem-solving abilities.
• Solid working knowledge of regulatory standards and requirements.

Responsibilities

• Audit delegated entities for compliance with regulatory requirements (CMS, DHCS, DMHC, LA Care).
• Review new regulations and oversee implementation by contracted medical groups, IPAs and plans.
• Monitor internal controls and organizational ownership structures; coordinate with internal departments.
• Lead corrective actions and follow-up activities to ensure timely remediation.
• Support health-equity objectives within delegated operations.

Skills

Auditing

Regulatory compliance

Internal controls

Critical thinking

Problem-solving

Education

Bachelor's degree or HS diploma/GED with 4+ years of experience in lieu

Job description

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee contracts with delegated entities, review regulations, and monitor performance against CMS, DHCS, DMHC, and LA Care requirements. Reporting to the Sr.

Manager, Delegation Operations, you will coordinate with internal departments, perform audits, corrective actions, and follow-up, and help strengthen internal controls while maintaining a focus on health equity and compliance in a hybrid in-office setting.