Government Programs Compliance Specialist, Senior

Blue Shield of California; California (MO); Hybrid; USD 91,000 - 136,000; Full time

Job summary

Blue Shield of California is seeking a Senior Government Programs Compliance Specialist to oversee Medicare Advantage and Part D materials, ensuring CMS and DHCS requirements are met. You will partner with business teams to promote regulatory compliance and corrective action.

The role involves risk-based monitoring, audits, and documenting final compliance solutions while maintaining an audit calendar and responding to inquiries.

Qualifications

• Requires a bachelor’s degree or equivalent experience.
• Requires a minimum of 5 years of relevant experience in Medicare compliance.
• Deep knowledge of CMS and DHCS requirements for plan materials.
• Excellent organizational skills and independent judgment.
• Proficiency with Microsoft Office, SharePoint, and HPMS; Project management experience is preferred.
• CHC certification is preferred.

Responsibilities

• Perform regulatory compliance reviews of Medicare Advantage and Part D materials and submit materials to CMS, DHCS as required.
• Document final compliance solutions, identified risks, and mitigation plans.
• Monitor implementation of corrective action plans and elevate issues as appropriate.
• Summarize and distribute updates to impacted areas.
• Provide day-to-day support for Medicare Advantage and Part D compliance inquiries.
• Maintain and manage department calendars, audits, mailboxes, intranet site, and policies.

Skills

CMS compliance

Regulatory risk

Analytical skills

MS Office

HPMS

SharePoint

Education

Bachelor’s degree or equivalent experience

Tools

HPMS

SharePoint

MS Office

Job description

Your Role

The Medicare Compliance team is responsible for providing oversight of Blue Shield’s Medicare Advantage and Part D plan operations to help ensure compliance with CMS regulations, contractual requirements, and internal policies. The Government Programs Compliance Specialist, Senior will report to the Senior Manager, Government Programs – Medicare Compliance. In this role, you will help support the effectiveness of the Medicare Compliance Program through risk-based monitoring, audits, and compliance activities that include evaluating the accuracy, completeness and integrity of plan materials, identifying compliance risks, and partnering with business teams to promote regulatory compliance and corrective action.

Job Description

Your Role

The Medicare Compliance team is responsible for providing oversight of Blue Shield’s Medicare Advantage and Part D plan operations to help ensure compliance with CMS regulations, contractual requirements, and internal policies. The Government Programs Compliance Specialist, Senior will report to the Senior Manager, Government Programs – Medicare Compliance. In this role, you will help support the effectiveness of the Medicare Compliance Program through risk-based monitoring, audits, and compliance activities that include evaluating the accuracy, completeness and integrity of plan materials, identifying compliance risks, and partnering with business teams to promote regulatory compliance and corrective action.

Responsibilities

Your Work

In this role, you will:

• Perform regulatory compliance reviews of Medicare Advantage and Part D plan member and marketing materials and (as required) submit materials to the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Care Services (DHCS).
• Document final compliance solutions, identified risks, and mitigation plans in a controlled document.
• Monitor implementation of corrective action plans to ensure remediation activities are on track, risks are identified, and mitigation plans are developed; elevate issues to department management as appropriate.
• Summarize and distribute low to complex federal and state updates to impacted business areas.
• Provide day-to-day support to business areas that support Blue Shield’s Medicare Advantage and Part D plans on low to moderately complex inquiries.
• Manage and maintain Medicare Compliance department activities e.g. development and maintenance of the department audit calendar, CMS, DMHC and DHCS audit calendar, department mailboxes, intranet website, policies and procedures, and other items as needed.
• Support calibration of risk and controls with business units supporting the Medicare line of business.
• Develop, prepare, and present analyses, reports, and recommendations to department management and other stakeholders of federal and state requirements
• Participate in multiple projects or initiatives within and outside of the department.
• Other duties as assigned.

Qualifications

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires a minimum of 5 years of relevant experience, inclusive of conducting compliance reviews of Medicare Advantage and Part D plan marketing and member communication materials
• Requires a deep knowledge of the Centers for Medicare & Medicaid Services’ (CMS) compliance requirements for Medicare Advantage and Part D plan member and marketing materials, as well as the Department of Health Care Services’ (DHCS) compliance requirements for exclusively aligned enrollment dual special needs plan member and marketing materials.
• Requires excellent organizational skills.
• Requires strong independent judgment, problem solving, critical and analytical skills, including an exceptional “moral compass” and work ethic.
• Requires ability to work collaboratively in a team, perform duties with minimal supervision, multi-task, and to deliver a quality product in a highly regulated, demanding, and constantly changing corporate environment.
• Requires proficiency in Microsoft Office suite programs (Word, Access, Excel, PowerPoint and Outlook), SharePoint, and the Health Plan Management System (HPMS).
• Project management or similar experience is preferred
• Professional certification (CHC – Certification in Healthcare Compliance) is preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity or disability status and any other classification protected by Federal, State and local laws.

JOB INFO

• Job Identification : 20261690
• Job Category : Legal and Compliance
• Posting Date : 2026-09-03T22:46:13+00:0
• Job Schedule : Full time
• Locations : Oakland, CA, United States
• Location : CA, United States
• Pay Range for California : $90860.00 to $136290.00
• Pay Range for Bay Area : $102424.00 to $153636.00
• Note : Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.
• Role can be filled by a candidate requiring sponsorship : No