Network Compliance Manager, Principal

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Blue Shield of California is seeking a Network Compliance Manager to oversee regulatory compliance across Commercial, Medicare Advantage, and Medi-Cal networks. You will serve as the primary liaison with state regulators and plan partners, guiding filings and transition planning for provider networks.

You will lead initiatives such as block transfers, termination transitions, member notification processes, and complex compliance challenges, requiring thoughtful judgment and collaboration with

Qualifications

• Bachelor's degree or GED with 4 years of relevant experience in lieu of a degree.
• 10 years of prior relevant experience is preferred.
• 5+ years of progressive experience in health plan compliance required.
• DMHC experience and block transfer experience strongly preferred.
• Strong interpersonal and written communication skills.
• Ability to work independently under limited supervision.
• Detail oriented with ability to manage complexity and shifting priorities.
• Advanced proficiency with MS Office including Word, PowerPoint and Excel.
• CHC designation or related credential preferred.

Responsibilities

• Serve as primary liaison with state regulators and plan partners.
• Ensure regulatory compliance across Commercial, Medicare Advantage, and Medi-Cal.
• Lead regulatory initiatives including block transfers and provider termination planning.
• Oversee member notification processes and required state filings.
• Exercise judgment to resolve complex compliance issues.

Skills

Interpersonal communication

Independent work

Detail oriented

MS Office proficiency

Regulatory compliance

Education

Bachelor's degree

GED or High School Diploma

Tools

MS Office

Job description

Your Role

The Network Compliance team collaborates to ensure regulatory compliance with regulations pertaining to HMO, PPO, Medicare, and Medi-Cal provider network disruptions. The Network Compliance Manager, Principal, will report to the Sr. Manager of Network Operations. In this role you will serve as the primary liaison with state regulators and plan partners, ensuring strong regulatory relationships while overseeing compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines of business. You will help lead critical regulatory initiatives, including block transfers, provider termination transition planning, member notification processes, and required state filings, while exercising judgment to resolve complex compliance issues.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree

  • 10 years of prior relevant experience

  • 5+ years of progressive experience in health plan compliance, required

  • DMHC experience and block transfer experience strongly preferred

  • Strong interpersonal and verbal and written communication skills

  • Works independently under limited supervision

  • Detail oriented and has the ability to deal with complexity, compressed timelines and shifting priorities

  • Advanced proficiency with MS Office products is required, including Word, PowerPoint and Excel.

  • CHC designation or another related credential 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.