Full-Time
Delegation Operations Auditor
Consultant
Posted on 9/4/2026
Blue Shield of California
5,001-10,000 employees
California nonprofit health insurance provider
Compensation Overview
$102.8k - $174k/yr
Lodi, CA, USA + 8 more
More locations: Redding, CA, USA | Long Beach, CA, USA | California, USA | Rancho Cordova, CA, USA | Woodland Hills, Los Angeles, CA, USA | Oakland, CA, USA | El Dorado Hills, CA, USA | San Diego, CA, USA
Hybrid
Hybrid role requiring office attendance two days each week for most teams; employees over 50 miles from an office coordinate in-office time based on business need.
Bachelor's
 Risk & Compliance (1) |
|---|
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- A Bachelor's degree, or a High School Diploma/GED with four years of additional relevant experience in lieu of a degree.
- Seven years of prior relevant experience auditing delegated entities for Department of Health Care Services requirements specific to provider training and education related to diversity, equity, and inclusion, with an emphasis on health equity.
- Strong experience auditing internal controls and knowledge of health care delegated functions to ensure delegated providers understand and meet Centers for Medicare & Medicaid Services, Department of Health Care Services, and Department of Managed Health Care requirements.
- Experience with delegated provider group relations.
- Strong critical-thinking, analytical, and problem-solving skills.
- Strong working knowledge of regulatory standards and regulations.
- Oversee policy and procedure reviews and complete full or complex desk, pre-delegation, annual, or follow-up onsite audits and assessments of delegated entities, including vendors, in support of regulatory and National Committee for Quality Assurance requirements.
- Act as the auditor in charge on large and complex audits of provider claims, provider dispute mechanisms, credentialing, and other delegated non-clinical areas through corrective action plan oversight.
- Perform special audits of providers as requested by regulators, contracting, and internal management.
- Research and investigate delegated entities' compliance with reporting requirements by tracking receipt and evaluating report completeness.
- Educate delegated entities and vendors on areas of expertise, including claims payment management, credentialing management, financial solvency, and system controls.
- Provide highly complex analysis and define efficiency in relation to compliance programs and internal controls.
- Collaborate on regulatory audits and findings responses.
- Provide or coordinate technical assistance to delegates to ensure compliance with requirements.
- Assist the Compliance Operations Advisor on regulatory enforcement audits.
- Assist in developing delegation policies and procedures and associated staff training.
- Assist in developing audit tools and correspondence templates for external entities.
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
N/A
Total Funding
N/A
Headquarters
null
Founded
1939
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Simplify's Take
What believers are saying
- February 2026 ACCESS commitment strengthens Blue Shield's value-based care positioning with CMS.
- August 2026 Availity and Symphony integrations streamline authorizations and provider-directory operations.
- August 2026 MCO-tax pricing excludes $8.85 PMPM from 2027 large-group rates, easing renewals.
What critics are saying
- July 2026 WARN notices cut 69 workers; 2025-2026 layoffs signal ongoing operating strain.
- In re Blue Shield privacy litigation still targets member-portal tracking pixels after July 2026 dismissal.
- Leadership churn persists after March 2025 CEO change and August 2026 COO replacement.
What makes Blue Shield of California unique
- Blue Shield of California combines nonprofit status, statewide California focus, and nearly 6 million members.
- August 2026 agreements with Cedars-Sinai, Providence, and Community Medical Centers preserve elite network access.
- Directly managed behavioral health since January 2026, tightening control over quality, utilization, and cost.
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Benefits
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Company News
Back-to-School: 3 easy, healthy breakfast recipes for busy families. Blue Shield's certified nutrition coach Angie Kalousek Ebrahimi shares simple, protein-packed breakfasts that help kids and families stay energized throughout the school day. August 28, 2026 As students are heading back to the classroom, mornings can quickly become a race against the clock. Between packing lunches, coordinating schedules, and getting everyone out the door on time, breakfast is often an afterthought. But according to Angie Kalousek Ebrahimi, senior director of Clinical Product Strategy and Innovation at Blue Shield of California and a certified nutrition coach, a protein-filled breakfast can help both kids and adults start the day strong. "Protein helps you stay fuller longer, supports steady energy, maintains muscle health, and can help regulate blood sugar throughout the morning," she said. "The good news is that healthy breakfasts don't need to be time-consuming or expensive." To make school mornings easier, Kalousek Ebrahimi recommends three simple, protein-rich recipes from the Thrive Global Cookbook, a collaboration between Thrive Global and Blue Shield of California Promise Health Plan. The cookbook is available online at no cost and includes dozens of nutritious recipes designed to be affordable and easy to prepare. 3 quick, protein-packed breakfast ideas * Energy-boost smoothie: Made with yogurt, milk, frozen strawberries, spinach, and nut butter, the energy-boost smoothie comes together in just minutes and can be customized based on dietary preferences or allergies. For families looking for additional sweetness, a ripe banana is a great addition. * Strawberry parfait: Layered with yogurt, fresh strawberries, and almonds or seeds, this strawberry parfait provides protein, fiber, and nutrients in a grab-and-go format. It's also easy to adapt using seasonal fruit or pantry staples. * Four-ingredient muffins: A simple make-ahead option, these four-ingredient muffins can be personalized with add-ins like blueberries, coconut flakes, or chocolate chips. The smoothie and parfait both feature yogurt, an easy source of protein for busy mornings. For an extra protein boost, Kalousek Ebrahimi recommends using unsweetened Greek yogurt, which typically contains about twice the protein of traditional yogurt and less sugar. Making healthy eating easier One of the cookbook's biggest advantages is its flexibility. Many of the recipes use everyday ingredients that families already have at home, and can be adapted to fit different tastes, dietary needs, and budgets. "At Blue Shield Promise, we know families are balancing a lot, especially during back-to-school season," said Kristen Cerf, president and CEO of Blue Shield of California Promise Health Plan. "The Thrive Global Cookbook offers simple, nutritious recipes that make healthy eating more accessible and achievable. Whether it's a quick breakfast before school or a healthy dinner after a busy day, having easy, nutritious options can help families build healthy habits that support their overall well-being." The Thrive Global Cookbook includes dozens of recipes for breakfast, lunch, dinner, snacks, and beverages, with options for vegetarian, vegan, gluten-free, dairy-free, and diabetes-friendly diets, and many meals can be prepared in 15 minutes or less. Download the Thrive Global Cookbook - available in 11 languages - a collaboration from Blue Shield of California Promise Health Plan and Thrive Global, the behavior change technology company founded by Arianna Huffington. For more nutrition tools, recipes, and lifestyle support, available at no additional cost to most Blue Shield members, visit its digital lifestyle-medicine platform, Wellvolution. Click below to watch Angie Kalousek Ebrahimi's FOX40 appearance featuring healthy back-to-school recipes
Blue Shield shares 2027 HSA, Small Group and MCO tax updates. Blue Shield of California has released several updates affecting Small and Large Group business, including new 2027 HSA-compatible plan deductible requirements, its upcoming Small Business Broker Roadshow and an update on the California Managed Care Organization (MCO) tax. 2027 hsa-compatible plan deductible changes. The IRS has increased the minimum deductible requirements for HSA-compatible plans for 2027.Beginning in 2027: * The individual deductible increases to $1,750, from $1,700. * The family deductible, or individual deductible on a family plan, increases to $3,500, from $3,400. The changes apply to both Small and Large Group HSA-compatible plans. AMA updates maternity care coding for 2027. Effective January 1, 2027, the American Medical Association (AMA) is changing CPT codes used for maternity care services.According to Blue Shield, the updated coding is intended to improve transparency and reporting across a member's maternity care. Small Business Broker Roadshow - September 22. Blue Shield will host its annual Small Business Broker Roadshow on September 22, 2026, at 1 p.m.The webinar will cover Blue Shield's Q1 2027 Small Business updates. Register for the Small Business Broker Roadshow Large Group MCO tax pricing update. Blue Shield also provided an important update regarding California's Managed Care Organization (MCO) tax.The anticipated $8.85 per member per month MCO tax will be excluded from January 1, 2027, fully insured and flex-funded Large Group renewal and new business rates. Groups that have already received quoted rates that included the tax will receive revised pricing.CMS approval and regulatory guidance remain pending. Blue Shield notes that it may make future pricing adjustments, potentially retroactive, if the tax is approved and determined to be applicable.
Blue Shield of California announces healthcare executive leader Frank Caporusso as chief operating officer. August 27, 2026 OAKLAND, California (August 27, 2026) - Blue Shield of California today announced Frank Caporusso as chief operating officer to lead the nonprofit health plan's operations and support its transformation strategies to better serve its nearly 6 million members. Caporusso will step into a reconfigured chief operating officer role on September 1, following the departure of COO Susan Mullaney, who will leave the health plan to pursue other opportunities. The role will support Blue Shield's strategy and future direction. "Susan has made important contributions to Blue Shield of California and has been a valued member of our leadership team," said Mike Stuart, president and CEO, Blue Shield of California. "We are grateful for her leadership, the work she did to prepare Blue Shield for this next phase, and her commitment to our employees, members, and the communities we serve. We wish her every success in what comes next." Caporusso is a healthcare executive veteran who joined Blue Shield of California two years ago and currently serves as senior vice president of the health plan's Healthcare Quality and Affordability Operations. In that role, he has been instrumental in creating an end-to-end view of the business division's operations to help ensure its strategy, clinical priorities, provider partnerships, operational execution, financial performance, and measurable outcomes are interconnected. "Frank brings deep knowledge of Blue Shield and the people we serve, along with a proven track record of leading through complexity and delivering results," Stuart said. "I am excited to have Frank step into this role and help us ensure we are there for our members." As COO, Caporusso will oversee enterprise-wide health plan operations and work closely with the executive leadership team to advance Blue Shield's strategy, and deliver an exceptional experience for members and providers. "I'm honored to take on this role and build on the strong foundation our team has created," Caporusso said. "I'm deeply committed to our employees, our members, and our nonprofit mission. I look forward to working alongside colleagues across the organization as we continue to serve our members."
Blue Shield of California and Cedars-Sinai Health System extend long-term partnership into the next decade. New Agreement Ensures Continued Access to Cedars-Sinai's Nationally Recognized Care, While Advancing Shared Goals for Quality, Patient Experience and Affordability Strategic partnership between Blue Shield of California and Cedars-Sinai Health System. Blue Shield of California and Cedars-Sinai Health System have reached a new long-term agreement that ensures the nonprofit health plan's Commercial HMO and PPO members will continue to have in-network access to Cedars-Sinai Health System facilities and providers throughout Southern California. The four-year agreement builds on a longstanding relationship that has connected Blue Shield members with Cedars-Sinai Health System's nationally recognized care and establishes a framework for continued collaboration in the decade ahead, focused on quality, improved outcomes, and affordability. The renewed collaboration includes Cedars-Sinai Medical Center, Cedars-Sinai Marina Hospital, Torrance Memorial Medical Center, Huntington Hospital, affiliated ambulatory surgery centers and ancillary providers, as well as providers participating in the Cedars-Sinai, Torrance Memorial, and Huntington Health physician networks. Together, Blue Shield and Cedars-Sinai Health System remain committed to delivering access to care, exceptional member experience, and greater value for Californians. "As a nonprofit health plan, we work closely with leading providers like Cedars-Sinai Health System to modernize the healthcare system while enhancing patient outcomes," said Mike Stuart, president and CEO of Blue Shield of California. "Cedars-Sinai Health System recognizes the importance of a coordinated approach to supporting the health of our members. We are pleased they will remain in our network and look forward to advancing strategic initiatives." "Our commitment to Los Angeles is rooted in providing the highest level of patient care while ensuring affordability and continuously improving health outcomes for our community," said Peter L. Slavin, MD, president and CEO of Cedars-Sinai Health System. "By working closely with Blue Shield, we are helping to build a more connected and equitable healthcare system that truly serves the people of Southern California." More news. August 11, 2026
Blue Shield of California has appointed Kedar S. Mate, MD, to its board of directors. Dr Mate is chief medical officer of Qualified Health AI, a digital health company focused on helping healthcare organisations deploy artificial intelligence technologies. He previously served as president and CEO of the Institute for Healthcare Improvement. Dr Mate brings over 20 years of experience in healthcare quality, patient safety, and health system transformation. He has advised leading healthcare organisations and government agencies, including the World Health Organization and Centers for Medicare & Medicaid Services. Dr Mate is a senior scholar at Stanford University's Clinical Excellence Research Center and practises internal medicine at New York Presbyterian Hospital. Blue Shield of California is a nonprofit health plan with nearly 6 million members and over $28 billion in annual revenue.