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Blue Shield of California · 1 hour ago

Compliance and Ethics Program Specialist, Senior

California, United States

Full-time

Hybrid

Senior Level

5+ years exp

Blue Shield of California is a nonprofit organization committed to transforming healthcare to be affordable and of high quality. They are seeking a Senior Compliance and Ethics Program Specialist to lead the compliance and ethics program, ensuring adherence to policies and providing guidance across various departments.

Financial ServicesHealth InsuranceNon Profit

Responsibilities

Provide guidance, quality review and execution of compliance and ethics case management and compliance activities

Responds to inquiries and provides advice and guidance regarding BSC's Code of Conduct, Corporate Compliance owned policies, and C&E Program operations. Triage and refer cases or inquiries to other BSC compliance resources (e.g., Privacy Office, SIU, Employee Relations)

Support the coordination and management of the Corporate Compliance & Ethics communication portals including email boxes, web applications, and Navex EthicsPoint hotlines

Designs and develops presentations and resources, implements and promotes awareness of the organization's compliance and ethics policies and the Code of Conduct

Review and analyze compliance metrics, performance data, and monitoring results to identify trends and areas requiring improvement

Proactively supports Conflict of Interest (COI) disclosure and assessment activities, including reviewing and responding to guidance requests pertaining to COIs and handling of disclosures

Serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. This includes staying current with industry trends and regulatory changes, proactively and continuously improving the compliance program to address new challenges and requirements

Coordinate and respond to requests for Compliance Program documentation and records including surveys, assessments, compliance certifications, attestations, and audit related requests for C&E records

Collaborate with colleagues and stakeholders across the BSC enterprise to drive compliance and ethics workplans and projects and exercise independent drive and judgment to suggest and move forward program improvements and priorities

Collaborate, as necessary, with other compliance resources (e.g., Privacy, IT Security, Human Resources, operational management) with respect to identified compliance issues

Develops and delivers compliance training curricula that are focused on the essential elements of the compliance program

Collaborate with colleagues and stakeholders to draft and deliver presentations related to compliance and ethics program work and priorities, risks, and metrics

May manage major/complex projects involving delegation of work and review of work products

Qualification

Healthcare Compliance CertificationHealthcare Regulations KnowledgeProject Management ExperienceData Analysis SkillsAdvanced Presentation SkillsWritten CommunicationVerbal CommunicationCritical ThinkingCollaboration SkillsTime ManagementOrganizational SkillsProblem-Solving Skills

Required

Requires a Bachelor's degree; Masters in relevant field or Juris Doctor preferred

Requires a minimum of 5 years of prior relevant experience (experience in a health plan or related health care organization preferred)

Exceptional written and verbal communication skills, including the ability to explain complex regulatory requirements to diverse audiences

Working knowledge of healthcare regulations and compliance requirements, including the DOJ Federal Sentencing Guidelines, OIG Compliance Plan, Privacy Rules, Stark Law, Anti-kickback statute, and Fraud and Abuse

Experience collecting and analyzing data and developing sophisticated reports on compliance and ethics data and metrics

Advanced presentation skills, including PowerPoint, Excel, Word

Experience and success in program/project management and driving change

Key necessary competencies include critical thinking, business acumen, collaboration, ability to influence others, strong written and verbal communication, efficient time management, and excellent organizational & problem-solving skills