Healthcare Compliance Program Specialist & Consultant

Blue Shield of CA; Oakland (CA); Hybrid; USD 130,000 - 170,000; Full time

Job summary

Blue Shield of California is seeking a Commercial Program Compliance Specialist, Consultant to support development and execution of the mandate validation and oversight program. You will conduct evidence-based reviews, partner with cross-functional stakeholders, and help mature governance, processes, tools, and reporting to strengthen compliance across the commercial portfolio.

The hybrid role requires in-office presence two days per week, with location-based arrangements; strong knowledge of

Qualifications

• Requires deep knowledge of regulatory compliance standards and processes.
• Requires knowledge of Knox-Keene Act, CCR Titles 22 and 28, and CFR Title 42 compliance standards.
• Experience in developing, enhancing, or operationalizing compliance programs, processes, tools, or frameworks.
• Ability to research complex compliance matters, analyze information from multiple sources, and provide actionable recommendations.
• Experience using compliance management systems, data tracking tools, or similar technology for oversight and reporting.

Responsibilities

• Support development and execution of the commercial mandate validation and oversight program.
• Conduct evidence-based reviews of implemented requirements.
• Partner with cross-functional stakeholders to assess compliance effectiveness.
• Help strengthen and mature program processes, tools, reporting, and governance.

Skills

Regulatory compliance

Analytical thinking

Problem solving

Cross-functional collaboration

Documentation & reporting

Education

Bachelor's degree or equivalent

High School Diploma with 4 years relevant experience

Tools

Microsoft Word

Microsoft Access

Microsoft Excel

Microsoft PowerPoint

Microsoft Outlook

Job description

Blue Shield of California is seeking a Commercial Program Compliance Specialist, Consultant to support development and execution of the mandate validation and oversight program. You will conduct evidence-based reviews, partner with cross-functional stakeholders, and help mature governance, processes, tools, and reporting to strengthen compliance across the commercial portfolio.

The hybrid role requires in-office presence two days per week, with location-based arrangements; strong knowledge of