Principal Network Compliance Lead - Hybrid

Blue Shield of CA; San Diego (CA); Hybrid; USD 120,000 - 160,000; Full time

Job summary

Blue Shield of California seeks a Network Compliance Manager to lead regulatory integrity across Commercial, Medicare Advantage, and Medi-Cal networks. You’ll serve as the primary liaison with state regulators and plan partners, guiding filings and compliance with evolving state rules.

You will drive key initiatives including block transfers, provider termination transition planning, and member notification processes while balancing complex timelines and business needs in a hybrid work

Qualifications

• Bachelor's degree or GED with 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
• DMHC experience and block transfer experience strongly preferred
• Advanced proficiency with MS Office (Word, PowerPoint, Excel)

Responsibilities

• 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
• Help lead critical regulatory initiatives, including block transfers, provider termination transition planning, member notification processes, and required state filings
• Lead and support leadership in developing and sustaining high-performing teams while managing complex compliance issues

Skills

Interpersonal skills

Verbal and written communication

MS Office proficiency

Independent worker

Detail oriented

Education

Bachelor's degree or HS Diploma/GED

CHC designation (preferred)

Job description

Blue Shield of California seeks a Network Compliance Manager to lead regulatory integrity across Commercial, Medicare Advantage, and Medi-Cal networks. You’ll serve as the primary liaison with state regulators and plan partners, guiding filings and compliance with evolving state rules.

You will drive key initiatives including block transfers, provider termination transition planning, and member notification processes while balancing complex timelines and business needs in a hybrid work