Director, Health Plan Compliance & Privacy

Blue Cross Blue Shiel; Columbia (SC); Hybrid; USD 75,000 - 110,000; Full time

Benefits offered by this job

401k retirement savings plan with公司匹配

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is seeking a senior compliance professional to oversee pharmacy benefit compliance and HIPAA/ERISA control across multiple jurisdictions from Columbia, SC. The role combines policy drafting, contract language oversight, and coordination with senior management to ensure regulatory alignment.

You will lead privacy/security program design, support URAC/NCQA expectations, and supervise licensing; a hybrid schedule is required with onsite and remote work weeks.

Qualifications

• Bachelor's degree in a job-related field.
• At least 10 years in claims, customer service, appeals, compliance administration or health insurance.
• 3+ years of supervisory/leadership experience.
• Familiarity with audit or compliance procedures and regulations.
• Strong customer service orientation.
• Excellent verbal and written communication across organization levels.
• Analytical, critical thinking and problem-solving capabilities.
• Ability to adapt in a changing environment; ability to persuade/negotiate.
• Discretion and confidentiality; strong attention to detail.
• Proficiency with Microsoft Office.

Responsibilities

• Develops solutions and action plans for major business opportunities.
• Assesses and evaluates potential business partners.
• Designs and implements Privacy and Security compliance programs.
• Assists in developing policies and procedures aligned with federal/state requirements.
• Directs Patriot Act compliance initiatives.
• Oversees AML screening and risk for high-risk products and channels.
• Drafts contract language for agency contracts, endorsements, certificates and booklets.
• Coordinates benefits with Senior Management and external personnel.

Skills

Leadership

Communication skills

Analytical thinking

Problem solving

Microsoft Office

Attention to detail

Education

Bachelor's degree in a related field

Job description

BlueCross BlueShield of South Carolina is seeking a senior compliance professional to oversee pharmacy benefit compliance and HIPAA/ERISA control across multiple jurisdictions from Columbia, SC. The role combines policy drafting, contract language oversight, and coordination with senior management to ensure regulatory alignment.

You will lead privacy/security program design, support URAC/NCQA expectations, and supervise licensing; a hybrid schedule is required with onsite and remote work weeks.