Senior Health Plan Compliance Lead

Blue Cross and Blue Shield of North Carolina; Durham (NC); On-site; USD 81,000 - 130,000; Full time

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Senior Compliance Advisor for the State Health Plan (SHP) to lead the ongoing maintenance of a robust compliance program. The role coordinates complex, cross-functional matters across physical and behavioral health benefits, Case Management, and vendor relationships.

You will interpret requirements, develop corrective action plans, and conduct audits to ensure adherence to NCQA standards, state regulations, ERISA, MHPAEA, and related

Qualifications

• Bachelor's degree or advanced degree.
• 5+ years of experience in healthcare compliance or related field.
• Experience navigating NCQA standards, state insurance requirements, ERISA, MHPAEA.

Responsibilities

• Apply deep healthcare compliance expertise to resolve complex, enterprise-wide questions affecting SHP benefits and operations.
• Serve as a compliance subject matter expert for Case Management and Utilization Management.
• Research and interpret new requirements and translate them into actionable policies and controls.
• Advise leaders on compliance implications and practical solutions balancing obligations and operations.
• Lead cross-functional collaboration with Legal, Clinical, Vendor Management, and Operations teams.

Skills

Regulatory compliance

Healthcare operations

Cross-functional leadership

Analytical thinking

Education

Bachelor's degree or advanced degree

Job description

Blue Cross and Blue Shield of North Carolina is seeking a Senior Compliance Advisor for the State Health Plan (SHP) to lead the ongoing maintenance of a robust compliance program. The role coordinates complex, cross-functional matters across physical and behavioral health benefits, Case Management, and vendor relationships.

You will interpret requirements, develop corrective action plans, and conduct audits to ensure adherence to NCQA standards, state regulations, ERISA, MHPAEA, and related