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Blue Shield of California · 11 hours ago

Sr. Manager, Commercial Program Compliance

California, United States

Full-time

Hybrid

Senior Level, Lead/Staff

8+ years exp

Blue Shield of California is a nonprofit organization focused on transforming healthcare to be more affordable and effective. They are seeking a Senior Manager for Commercial Compliance to lead the validation oversight of regulatory mandates and manage a team of compliance professionals. The role involves developing auditing and monitoring programs to ensure adherence to compliance standards across the organization.

Financial ServicesHealth InsuranceNon Profit

Responsibilities

Lead the development and execution of the annual validation oversight plan for implemented mandates

Manage a small team of compliance professionals, providing strategic direction, coaching, and performance management

Oversee the validation of implemented mandates by reviewing compliance artifacts such as controls, documentation, and system configurations

Design and implement robust auditing, monitoring, and testing programs to assess post-implementation effectiveness

Collaborate with cross-functional teams to ensure mandates are accurately translated into operational practices

Identify gaps or deficiencies in execution of mandates and recommend corrective actions

Maintain detailed records of validation activities and ensure timely reporting to senior leadership and audit committees

Stay current on regulatory developments and industry best practices to inform validation strategies

Qualification

Regulatory compliance knowledgeHealthcare industry expertiseAuditingMonitoring programsProject management toolsGovernance risk compliance softwareDelegation skillsLeadership skillsCritical thinkingCommunication skillsDecision-making skillsTeam management

Required

Requires a Bachelor's degree

Requires a minimum 8 years prior relevant experience, including 4 years of management experience

Requires a minimum of 7 years of demonstrated experience working with health plan operations and leadership or regulatory compliance experience, and a minimum of 4 years experience working in a health plan compliance environment

Requires Strong knowledge and broad understanding of the regulatory and compliance aspects of the healthcare industry, its products, and practices

Requires advanced technical and functional expertise with systems and tools used in project management, business acumen, risk management, delegation skills, critical thinking, and decision-making skills

Requires a sound understanding of the Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes and has demonstrated experience in working with mandates

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