Senior Network Compliance & Regulatory Liaison

Blue Shield of CA; Lodi (CA); Hybrid; USD 140,000 - 180,000; Full time

Job summary

Blue Shield of CA seeks a Network Compliance Manager, Principal, to ensure regulatory compliance for HMO, PPO, Medicare Advantage, and Medi-Cal provider networks. You will report to the Sr.

Manager of Network Operations and serve as the primary liaison with state regulators and plan partners, guiding complex regulatory initiatives. You will lead block transfers, provider termination transition planning, member notification processes, and state filings while supervising strategy and execution

Qualifications

• Bachelor's degree or GED plus 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 verbal and written communication skills
• Works independently under limited supervision
• Detail oriented with ability to manage complexity, compressed timelines and shifting priorities
• Advanced proficiency with MS Office (Word, PowerPoint, Excel)
• CHC designation or related credential preferred

Responsibilities

• Serve as primary liaison with state regulators and plan partners to ensure regulatory relationships
• Oversee compliance with evolving state requirements across Commercial, Medicare Advantage, and Medi-Cal lines of business
• Lead regulatory initiatives including block transfers and provider termination transition planning
• Manage member notification processes and required state filings
• Collaborate with leadership and teams to resolve complex compliance issues
• Support hybrid workplace model with in-office collaboration as needed

Skills

Interpersonal communication

Verbal and written communication

Independent work

Detail oriented

Time management

MS Office proficiency

Education

Bachelor's degree or High School Diploma/GED

Tools

MS Office (Word, PowerPoint, Excel)

Job description

Blue Shield of CA seeks a Network Compliance Manager, Principal, to ensure regulatory compliance for HMO, PPO, Medicare Advantage, and Medi-Cal provider networks. You will report to the Sr.

Manager of Network Operations and serve as the primary liaison with state regulators and plan partners, guiding complex regulatory initiatives. You will lead block transfers, provider termination transition planning, member notification processes, and state filings while supervising strategy and execution