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Compliance and Ethics, Consultant

Blue Shield of California
Full-time
On-site
Oakland, California, United States
Compliance Officer
Description

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. The Compliance and Ethics, Consultant is a critical individual contributor and leader who will report to the Senior Manager, Compliance and Ethics. 

In this role you will work closely with the Senior Manager and department to 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, etc., and serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.



Responsibilities

Your Work

In this role, you will:

  • 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.
  • Lead the coordination and management of the Corporate Compliance & Ethics communication portals including email boxes, web applications, and Navex EthicsPoint hotlines.
  • Respond to complex inquiries regarding BSC's Code of Conduct, Compliance with Corporate Policies and Corporate Compliance & Ethics Program, including referrals to other compliance resource areas (e.g., Privacy, Special Investigations, Human Resources).
  • 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.
  • 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. 
  • Drafts, develops, obtains management approval for C&E program operational workflows, policies, protocols, and procedures. 
  • Develop, coordinate, and deliver compliance training programs that are focused on the essential elements of the compliance program. 
  • Assist in the management and deployment of the organization conflicts of interest program, including partnering with internal audit on developing annual Conflicts of Interest Survey improvements. 
  • Develop, perform, and deliver C&E Program data reporting and metric analysis. Draft and assist with C&E reporting activities (e.g., BSC governance committees, Audit Committee, Board of Directors).
  • Draft and deliver presentations related to compliance and ethics program work and priorities, risks, and metrics. 


Qualifications

Your Knowledge and Experience

  • Requires a Bachelor’s degree; Masters in relevant field or Juris Doctor highly preferred.
  • Requires a minimum of 7 years of prior relevant experience (experience in a health plan or related health care organization preferred).
  • Requires Certification in Healthcare Compliance (CHC) or Certified Ethics and Compliance Professional (CCEP).
  • Experience driving, leading, managing, implementing, and maintaining corporate compliance and ethics program projects from hotline implementation to compliance program assessments and communication and training programs.
  • 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.