Delegation Operations Auditor: Regulatory Compliance

Blue Shield of CA; Redding (CA); Hybrid; USD 95,000 - 130,000; Full time

Job summary

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee audits of contracted entities and ensure compliance with CMS, DHCS, DMHC, and LA Care requirements.

You will review new regulations, coordinate with internal departments, and monitor internal controls across delegated provider groups, IPAs, and specialty plans, with emphasis on health equity. This hybrid role requires in-office collaboration two days weekly.

Qualifications

• Requires a Bachelor's degree or High School Diploma/GED with 4 years of additional relevant experience
• Requires 7 years of auditing delegated entities for DHCS requirements with focus on health equity
• Strong knowledge of CMS, DHCS, DMHC and other regulatory standards
• Experience with delegated provider group relations
• Strong critical thinking, analytical, and problem-solving skills
• Hybrid workplace model with in-office 2 days per week

Responsibilities

• Review new regulations and oversee implementation by contracted medical groups, IPAs, and specialty and RKK Plans
• Oversee internal controls related to ownership, organizational structure, and other complex issues per DMHC, DHCS, CMS, and LA Care requirements
• Coordinate with internal departments to monitor and audit delegated entities
• Ensure compliance with contractual and regulatory requirements
• Lead oversight activities with a focus on health equity and diversity, equity, and inclusion

Skills

Auditing delegated entities

Regulatory standards knowledge

Internal controls auditing

CMS/DHCS/DMHC knowledge

Provider group relations

Critical thinking

Analytical skills

Problem-solving

Health equity awareness

Education

Bachelor's degree or High School Diploma/GED with 4 years experience

Job description

Blue Shield of California is seeking a Delegation Operations Auditor, Consultant to oversee audits of contracted entities and ensure compliance with CMS, DHCS, DMHC, and LA Care requirements.

You will review new regulations, coordinate with internal departments, and monitor internal controls across delegated provider groups, IPAs, and specialty plans, with emphasis on health equity. This hybrid role requires in-office collaboration two days weekly.