Mandate Validation Compliance Consultant

Blue Shield of California; California (MO); Hybrid; USD 112,000 - 167,000; Full time

Job summary

Blue Shield of California seeks a Commercial Program Compliance Specialist, Consultant to lead mandate validation and oversight for the Commercial business. You will conduct evidence‑based reviews, partner with cross‑functional teams, and support governance and processes as the program evolves.

You will work in a hybrid environment, performing complex analyses and delivering actionable recommendations. A strong compliance background and ability to manage audits are essential for success.

Qualifications

• Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• Requires 7 years of prior relevant experience in a healthcare setting, 4 of which were in a regulatory change management related role
• Requires deep knowledge of regulatory compliance standards and processes
• Requires knowledge of Knox‑Keene Act, California Code of Regulations Titles 22 and 28, and CFR Title 42 standards
• Requires ability to develop or operationalize compliance programs, processes, tools, or frameworks
• Requires ability to research complex compliance matters and deliver actionable recommendations
• Requires experience with compliance management systems and data tracking tools
• Requires excellent analytical and problem‑solving skills
• Requires familiarity with compliance risk assessments and audits
• Proficiency in Word, Access, Excel, PowerPoint and Outlook
• Professional healthcare compliance certifications (e.g., CHC) and/or advanced degree preferred

Responsibilities

• Execute and support the annual mandate validation and oversight program
• Review compliance artifacts to assess effectiveness of mandates and controls
• Conduct independent audits of complex compliance issues and assess operational effectiveness
• Advise cross‑functional stakeholders on compliant solutions for newly enacted and revised mandates
• Identify execution gaps, recommend corrective actions, and support risk calibration with business units
• Prepare and deliver complex analyses and reports to senior management and oversight committees
• Support development and continuous improvement of compliance validation processes, tools, procedures, and reporting
• Research and analyze complex compliance topics to support program development and decision‑making
• Build and maintain collaborative relationships with cross‑functional partners and SMEs
• Other duties as assigned

Skills

Regulatory compliance

Analytical thinking

Stakeholder collaboration

Risk assessment

Education

Bachelor's degree

Tools

MS Word

MS Excel

MS Access

PowerPoint

Outlook

Job description

Blue Shield of California seeks a Commercial Program Compliance Specialist, Consultant to lead mandate validation and oversight for the Commercial business. You will conduct evidence‑based reviews, partner with cross‑functional teams, and support governance and processes as the program evolves.

You will work in a hybrid environment, performing complex analyses and delivering actionable recommendations. A strong compliance background and ability to manage audits are essential for success.