Senior Healthcare Compliance Investigator

Blue Shield of CA; Long Beach (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Blue Shield of CA seeks a Compliance and Ethics Investigator, Consultant to conduct confidential investigations into misconduct, including potential fraud and policy violations. You will handle sensitive issues across the enterprise and translate findings for diverse audiences.

The role emphasizes collaboration with senior leaders, strong healthcare regulatory knowledge, and the ability to manage multiple priorities in a dynamic environment. CHC/CCEP preferred or obtainable within two years.

Qualifications

• Requires a Bachelor's degree or HS/GED with 4 years of relevant experience.
• Requires 7+ years in health care compliance, legal/privacy/investigations.
• Deep knowledge of healthcare compliance laws and regulations.
• Proficient in Excel with pivot-tables and formulas.
• Experience conducting internal investigations and reporting to senior leadership.
• Ability to translate investigation findings to diverse audiences.
• Ability to manage multiple priorities in a dynamic environment.
• Preferred: CHC or CCEP certification or ability to obtain within two years.

Responsibilities

• Perform confidential internal investigations into misconduct, including fraud and Code of Conduct violations.
• Investigate sensitive matters related to conflicts of interest and misuse of company assets.
• Work with senior leaders throughout investigations and present findings.
• Develop and maintain investigation processes and reporting.

Skills

Healthcare compliance

Investigations

Excel pivot-tables

Analytics with formulas

Communicating with senior leaders

Policy and regulatory knowledge

Independent judgment

Time management

Certification (CHC/CCEP) preferred

Education

Bachelor's degree

HS/GED with 4 years of experience

Tools

Excel

Job description

Blue Shield of CA seeks a Compliance and Ethics Investigator, Consultant to conduct confidential investigations into misconduct, including potential fraud and policy violations. You will handle sensitive issues across the enterprise and translate findings for diverse audiences.

The role emphasizes collaboration with senior leaders, strong healthcare regulatory knowledge, and the ability to manage multiple priorities in a dynamic environment. CHC/CCEP preferred or obtainable within two years.