Healthcare Compliance & Ethics Investigator

Blue Shield of CA; Lodi (CA); On-site; USD 90,000 - 140,000; Full time

Job summary

Blue Shield of California is seeking a Compliance and Ethics Investigator, Consultant, to conduct confidential internal investigations across the enterprise, addressing allegations related to misconduct, fraud, and policy violations. You will partner with leadership to ensure rigorous investigative standards and remediation where needed.

The role requires deep healthcare compliance knowledge, strong analytics in Excel, and the ability to translate complex findings for diverse audiences, while

Qualifications

• Bachelor’s degree or HS Diploma/GED with 4 years of additional relevant experience
• 7 years of prior relevant experience in health care compliance, legal services, privacy, investigative services, or related field
• Deep knowledge of healthcare compliance legislation and regulations
• Experience with Excel including pivot-tables and analytics
• Experience conducting internal investigations within a corporate or public entity
• Experience working with senior leaders through investigations
• Ability to translate sensitive, complex investigation findings to diverse audiences
• Ability to manage multiple priorities and meet deadlines in a dynamic environment
• Certified in Healthcare Compliance (CHC) or CC EP certification preferred or ability to obtain within two years

Responsibilities

• Perform confidential internal investigations into allegations of misconduct
• Address issues related to fraud, Code of Conduct violations, conflicts of interest, misuse of company assets, and regulatory concerns
• Prepare clear, evidence-based findings and executive-level briefings

Skills

Pivot tables

Investigations

Stakeholder communication

Independent judgment

Education

Bachelors or HS Diploma + 4 yrs experience

CHC/CCEP preferred

Tools

Excel

Job description

Blue Shield of California is seeking a Compliance and Ethics Investigator, Consultant, to conduct confidential internal investigations across the enterprise, addressing allegations related to misconduct, fraud, and policy violations. You will partner with leadership to ensure rigorous investigative standards and remediation where needed.

The role requires deep healthcare compliance knowledge, strong analytics in Excel, and the ability to translate complex findings for diverse audiences, while