Senior Network Compliance Lead: State Regulators

Blue Shield of California; California; Hybrid; USD 138,000 - 207,000; Full time

Job summary

Blue Shield of California is seeking a Network Compliance Manager, Principal, to lead regulatory initiatives across Commercial, Medicare Advantage, and Medi-Cal lines. You will liaise with state regulators and plan partners, oversee filings, and guide cross-functional teams through evolving state requirements.

You will build strong regulatory relationships, manage block transfers and timely access filings, and drive improvements in policies and processes while maintaining a high standard of

Qualifications

• Bachelor’s degree or High School Diploma/GED with 4 years of 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.
• Strong interpersonal and written/verbal communication skills.
• Works independently under limited supervision.
• Detail oriented with ability to handle complexity, tight timelines, and shifting priorities.
• Advanced proficiency with MS Office (Word, PowerPoint, Excel).
• CHC designation or related credential preferred.

Responsibilities

• Develop and sustain positive relationships with state regulators (DMHC, CDI, DHCS) and plan partners.
• Operationalize new and existing state requirements across Commercial, Medicare Advantage, and State-Sponsored Business.
• Manage Block Transfer and Timely Access Report filings for state review and related member notification processes.
• Assist other departments with compliance tasks such as enrollments, TAR filings, and other state filings.
• Oversee compliance reporting and present results to internal and external stakeholders.
• Develop and update policies relative to state filing requirements and respond to comments.
• Ensure compliance with state/federal orders and optimize operations under compliance conditions.
• Provide guidance and training on regulator-related matters.
• Drive process improvements with potential precedent-setting impact.

Skills

Regulatory compliance

Regulatory liaison

Project management

Regulatory reporting

Interpersonal communication

Independent work

Detail-oriented

MS Office (Word, PowerPoint, Excel)

CHC credential preferred

Education

Bachelor’s degree or HS diploma + 4 years experience

Tools

MS Office

Job description

Blue Shield of California is seeking a Network Compliance Manager, Principal, to lead regulatory initiatives across Commercial, Medicare Advantage, and Medi-Cal lines. You will liaise with state regulators and plan partners, oversee filings, and guide cross-functional teams through evolving state requirements.

You will build strong regulatory relationships, manage block transfers and timely access filings, and drive improvements in policies and processes while maintaining a high standard of