Senior Network Compliance Lead - Hybrid (In-Office 2 Days)

Blue Shield of CA; Oakland (CA); Hybrid; USD 130,000 - 180,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of CA in Oakland seeks a Network Compliance Manager, Principal, who will report to the Sr. Manager of Network Operations.

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 lead regulatory initiatives including block transfers, provider termination transition planning, member

Qualifications

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

Responsibilities

• Liaise with state regulators and plan partners to ensure regulatory compliance
• Oversee compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines
• Lead regulatory initiatives such as block transfers, provider termination transition planning
• Manage member notification processes
• Prepare and file required state filings

Skills

Interpersonal skills

Verbal communication

Written communication

Independent work

Detail oriented

MS Office

Education

Bachelor's degree

High School Diploma/GED

CHC designation or related credential

Tools

MS Word

MS PowerPoint

MS Excel

Job description

Blue Shield of CA in Oakland seeks a Network Compliance Manager, Principal, who will report to the Sr. Manager of Network Operations.

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 lead regulatory initiatives including block transfers, provider termination transition planning, member