Blue Shield of California

California nonprofit health insurance provider

Government Programs Compliance Specialist

Regulatory Compliance & EthicsConfirmed live in the last 24 hours

Full-time$33.99 - $57.47In-person

About the Job

Requirements

A bachelor's degree or equivalent experience is required.
At least 3 years of prior relevant experience is required.
Knowledge of Medi-Cal regulatory compliance standards and processes is required.

Responsibilities

Provide support for planning and identifying Medi-Cal requirements arising from ongoing, newly enacted, or revised regulatory requirements.
Support implementation of quality, repeatable, and documented compliance processes; escalate and propose resolutions for low-complexity requirements and process issues.
Support maintenance and enhancement of Medi-Cal Compliance tracking systems and/or applications.
Support Medi-Cal Compliance department activities, including development and maintenance of the department and external regulatory audit calendars, department mailboxes, intranet website, policies, procedures, and other items as needed.
Collect and retain data and develop low-complexity analyses and reports.
Assist with routine departmental functions and initiatives as needed.
Participate in multiple projects or initiatives within the job area and perform other duties as assigned.
Support ongoing alignment with Blue Shield and Promise strategy and company objectives.

Desired Qualifications

Professional certifications, including Certification in Healthcare Compliance (CHC), and additional degrees are preferred.

Your Role

The Blue Shield of California Promise Health Plan Compliance team is responsible for the administration and oversight of an effective compliance program. The Government Programs Compliance Medi-Cal Specialist, Experienced will report to the Government Programs Compliance Medi-Cal Manager, Senior Manager. In this role you will be providing support for the planning and identification of Medi-Cal requirements within the department due to ongoing, newly enacted, or revised federal or state regulatory requirements. This role also supports Medi-Cal Compliance department activities e.g. development & maintenance of the department audit calendar, CMS, DMHC and DHCS audit calendar, corrective action plans, department mailboxes, intranet website, policies and procedures, and other items as needed.

Your Knowledge and Experience

Requires a bachelor's degree or equivalent experience
Requires at least 3 years of prior relevant experience
Requires knowledge of Medi-Cal regulatory compliance standards and processes
Professional certifications (CHC –Certification in Healthcare Compliance) & additional degrees preferred

Your Work

In this role, you will:

Provide support for the planning and identification of Medi-Cal requirements within the department due to ongoing, newly enacted or revised regulatory requirements
Support the implementation of quality, repeatable and documented compliance processes and escalate and propose resolution for low complexity requirements and process issues
Support maintenance and enhancements to the Medi-Cal Compliance tracking system(s) and/or application(s)
Support Medi-Cal Compliance department activities including development & maintenance of the department audit calendar, external regulatory audit calendar, department mailboxes, intranet website, policies and procedures, and other items as needed
Be responsible for data collection, retention, and the development of low complexity analyses and reports
Assists with routine departmental functions and initiatives, as needed
Participates in multiple projects or initiatives within job area and other duties as assigned
Supports ongoing alignment with Blue Shield and Promise strategy and company objectives

Pay Range for California: $33.99 to $50.98

Pay Range for Bay Area: $38.31 to $57.47

About the Company

Blue Shield of California

California nonprofit health insurance provider

Blue Shield of California is a nonprofit health plan provider that offers medical insurance options for individuals, families, and employers within California. It operates as a mutual benefit corporation and maintains a broad network of healthcare professionals and facilities, enabling members to access care and manage claims through an online portal. Its services include preventive care programs and digital health coaching, with prior authorization required for certain medical, surgical, and some prescription drugs to control costs and ensure medical necessity. The company draws a substantial portion of its membership from CalPERS and focuses on delivering stable, affordable access to care within the state. Its goal is to provide members with reliable health coverage, a wide provider network, and tools to manage their health and expenses efficiently.

Company size: 5,001-10,000
Company stage: Not listed
Total funding: Not listed
Headquarters: United States
Founded: 1939

Recently Posted Jobs

Explore more opportunities at Blue Shield of California

See more jobs