Delegation Operations Auditor & Compliance Strategist

Blue Shield of CA; Oakland (CA); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee audits of contracted medical groups, IPAs, and specialty plans, ensuring compliance with CMS, DMHC, DHCS, and LA Care requirements that affect performance.

The role reviews new regulations, coordinates with internal departments on oversight activities, and oversees internal controls such as ownership and organizational structure.

Qualifications

• Bachelor's degree or HS diploma plus 4 years of relevant experience.
• 7 years auditing delegated entities for DHCS requirements.
• Experience auditing internal controls and regulatory standards.
• Experience with delegated provider group relations.

Responsibilities

• Oversee audits of contracted delegated entities and monitor compliance with applicable regulations.
• Review new regulations and oversee implementation by contracted medical groups, IPAs, and plans.
• Coordinate with internal departments on oversight activities and monitor corrective actions.
• Oversee internal controls including ownership and organizational structure to meet regulatory requirements.

Skills

Critical thinking

Analytical skills

Problem solving

Regulatory knowledge

Education

Bachelor's degree or HS Diploma/GED

4 years of relevant experience in lieu of a degree

Job description

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee audits of contracted medical groups, IPAs, and specialty plans, ensuring compliance with CMS, DMHC, DHCS, and LA Care requirements that affect performance.

The role reviews new regulations, coordinates with internal departments on oversight activities, and oversees internal controls such as ownership and organizational structure.