Blue Shield of California
Compliance and Ethics Program Specialist, Senior
Blue Shield of California, California, Missouri, United States, 65018
Compliance and Ethics Program Specialist, Senior
Get AI-powered advice on this job and more exclusive features. Your Role The Compliance and Ethics team ensures adherence to the BSC Code of Conduct and owns and coordinates the Company’s compliance and ethics program across the enterprise, including all business units, products, services and activities. This includes the implementation and maintenance of proper preventive, detective and remedial programs and controls; the execution of relevant policies and procedures; training and educating the workforce; implementing an effective communications program; ensuring effective testing, auditing, monitoring, tracking and reporting; and remediate control deficiencies. Job Description The Senior Level Compliance and Ethics Specialist is a critical individual contributor and program lead who will report to the Senior Manager, Compliance and Ethics. You will drive and lead the department’s strategic priorities and projects, including advancing the compliance training program, developing and implementing compliance policies such as the Conflict of Interest, Gifts and Entertainment, Anti‑Corruption, and serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. Responsibilities Provide guidance, quality review and execution of compliance and ethics case management and compliance activities. Respond to inquiries and provide 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. Support coordination and management of the Corporate Compliance & Ethics communication portals including email boxes, web applications, and Navex EthicsPoint hotlines. Design and develop presentations and resources, implement and promote 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 support 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, staying current with industry trends and regulatory changes, 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. 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 (Privacy, IT Security, Human Resources, operational management) with respect to identified compliance issues. Develop and deliver compliance training curricula 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. Qualifications Bachelor’s degree required; Master’s in relevant field or Juris Doctor preferred. Minimum of 5 years of prior relevant experience (experience in a health plan or related health care organization preferred). Certification in Healthcare Compliance (CHC) or Certified Ethics and Compliance Professional (CCEP) preferred. Exceptional written and verbal communication skills, including the ability to explain complex regulatory requirements to diverse audiences. Experience with project management preferred; excellent execution skills required. 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 competencies: critical thinking, business acumen, collaboration, influence, written and verbal communication, efficient time management, excellent organizational and problem‑solving skills. About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. Blue Shield of California’s mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We transform health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. We foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community‑minded companies in the United States by Points of Light. Equal Employment Opportunity External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
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Get AI-powered advice on this job and more exclusive features. Your Role The Compliance and Ethics team ensures adherence to the BSC Code of Conduct and owns and coordinates the Company’s compliance and ethics program across the enterprise, including all business units, products, services and activities. This includes the implementation and maintenance of proper preventive, detective and remedial programs and controls; the execution of relevant policies and procedures; training and educating the workforce; implementing an effective communications program; ensuring effective testing, auditing, monitoring, tracking and reporting; and remediate control deficiencies. Job Description The Senior Level Compliance and Ethics Specialist is a critical individual contributor and program lead who will report to the Senior Manager, Compliance and Ethics. You will drive and lead the department’s strategic priorities and projects, including advancing the compliance training program, developing and implementing compliance policies such as the Conflict of Interest, Gifts and Entertainment, Anti‑Corruption, and serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. Responsibilities Provide guidance, quality review and execution of compliance and ethics case management and compliance activities. Respond to inquiries and provide 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. Support coordination and management of the Corporate Compliance & Ethics communication portals including email boxes, web applications, and Navex EthicsPoint hotlines. Design and develop presentations and resources, implement and promote 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 support 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, staying current with industry trends and regulatory changes, 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. 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 (Privacy, IT Security, Human Resources, operational management) with respect to identified compliance issues. Develop and deliver compliance training curricula 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. Qualifications Bachelor’s degree required; Master’s in relevant field or Juris Doctor preferred. Minimum of 5 years of prior relevant experience (experience in a health plan or related health care organization preferred). Certification in Healthcare Compliance (CHC) or Certified Ethics and Compliance Professional (CCEP) preferred. Exceptional written and verbal communication skills, including the ability to explain complex regulatory requirements to diverse audiences. Experience with project management preferred; excellent execution skills required. 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 competencies: critical thinking, business acumen, collaboration, influence, written and verbal communication, efficient time management, excellent organizational and problem‑solving skills. About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. Blue Shield of California’s mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We transform health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. We foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community‑minded companies in the United States by Points of Light. Equal Employment Opportunity External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
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