Senior Compliance Oversight Consultant - PBM

BCBSM, Inc.; United States; Hybride; USD 79 000 - 131 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision insurance

Life insurance

401k

PTO

Résumé du poste

Blue Cross and Blue Shield of Minnesota is seeking a seasoned compliance professional to actively participate in compliance, risk management, and operational excellence. You will monitor internal and external operations, assess performance of vendors, and support regulatory audits while embedding compliance into daily processes.

Ideal candidates have 5+ years in compliance and a Bachelor's degree, with optional advanced certifications.

Qualifications

• 5+ years of related compliance & regulatory affairs professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience may be accepted.

Responsabilités

• Oversee ongoing monitoring of internal and external operations and CAPs.
• Plan and execute internal and external compliance assessments.
• Support external regulatory audits affecting a functional area and related entities.
• Provide regulatory insight in reviewing documents and written responses before submission.
• Assist in guiding and training junior staff involved in monitoring deliverables.

Connaissances

Regulatory compliance

Regulatory affairs

Audit support

CAP development

Cross-functional collaboration

Formation

Bachelor's degree

CCEP

CIA

CPA

CHC

Description du poste

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll Have

This position actively participates in the organization’s compliance, risk management, and operational excellence. Through monitoring and assessment of internal operations and external partners (First Tier, Downstream, and Related Entities (FDRs)/Subcontractors), the role ensures adherence to regulatory and organizational standards. Through proactive compliance reviews, effective audit support, and corrective action initiatives, this role helps safeguard the organization’s reputation and regulatory standing. The position may also oversee vendors, collaborating across departments and with external partners to embed compliance into daily processes to maintain readiness for regulatory review.

What You'll Do

Own ongoing monitoring of internal and external operations, and targeted deep dives into activities performed by Vendor Managers. Plan and execute internal and external compliance assessments. Provide guidance and support for external regulatory audits impacting a functional area and related FDR/subcontractors by offering regulatory insight reviewing documents and written responses prior to submission.

How You'll Do It

Contribute to the development and validation of Corrective Action Plans (CAP), provide consultation, and collaborate with internal teams and/or FDR/Subcontractors on CAP implementation. Document, collect, and organize information into clear, accurate reports and maintain records and related documentation for reporting to the Enterprise Ethics and Compliance (EEC) Leadership, Blue Cross leadership, EEC Committee members, the Board of Directors, and external regulators. Support and assist in guiding and training junior staff involved in monitoring and assessment deliverables. Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

5+ years of related compliance & regulatory affairs professional experience. Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• Medicare Part D compliance experience.
• PBM/pharmacy operational knowledge.
• PBM/FDR oversight or PBM compliance experience.
• Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.
• Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
• Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.
• Business analysis expertise, regulatory research, and ability to translate regulatory requirement into operation.
• Ability to interpret and apply applicable federal and state regulations.
• Healthcare or insurance industry experience.
• Experience with Medicare/Medicaid regulatory programs.
• Experience with CMS, DOH, and state regulatory filings.
• Experience drafting responses or presenting to boards, compliance committees, or regulatory bodies.

Licensure/Certifications

Nice to Have: Certified Compliance & Ethics Professional (CCEP) - Society of Corporate Compliance and Ethics (SCCE) Certified Internal Auditor (CIA) - Institute of Internal Auditors (IIA) Certified Public Accountant (CPA) - State Board of Accountancy Certified in Healthcare Compliance (CHC) - Health Care Compliance Association (HCCA).

Role Designation

• Hybrid Role designation definition: Teleworking is working full time remote.
• Hybrid is a minimum of 2 days onsite.
• Onsite is full-time onsite.

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Compensation and Benefits

$79,100.00 - $104,800.00 - $130,500.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affiliation Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [e-mail].

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements. Chartered in 1933 as Minnesota’s first health plan, this company is one of the most recognized and trusted healthcare brands in the world. It has more members, the largest network of doctors, and more products and services than any other health plan in Minnesota. Headquartered in Eagan, Minnesota.