Blue Shield Of California

Compliance and Ethics Program Investigator, Consultant

Blue Shield Of California • $95K — $115K *
Lodi, CA 95240In-Person
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree or High School Diploma/GED with 4 years of relevant experience in lieu of a degree
  • 7 years of experience in healthcare compliance, legal services, or investigative services
  • Deep knowledge of healthcare compliance legislation and regulations
  • Proficient in Excel, including pivot tables and analytics functions
  • Experience conducting internal investigations in corporate or public settings
  • Ability to communicate complex findings to diverse audiences
  • Experience managing multiple priorities in a dynamic environment
  • Preferred certification in Healthcare Compliance (CHC) or Compliance and Ethics Professional (CCEP) within two years.

Responsibilities

  • Conduct thorough internal investigations into compliance and ethics issues
  • Develop and execute investigation plans, identifying key evidence and witnesses
  • Conduct fact-finding interviews and analyze data to write investigation reports
  • Maintain accurate case documentation and ensure compliance with program standards
  • Present findings to stakeholders including management and Employee Relations
  • Identify root causes and recommend corrective actions, tracking their completion
  • Collaborate with experts in Privacy, Legal, IT, and Internal Audit on compliance issues
  • Manage a caseload of concurrent investigations, meeting quality and timeliness standards
  • Promote a culture of ethics and compliance across the organization.

Benefits

  • Flexible workplace model with in-office collaboration two days a week
  • Support for employees with medical conditions through reasonable accommodations
  • Opportunities for personal and professional growth
  • Engagement in a culture that values ethics and compliance
  • Access to training and development programs.
Full Job Description
Job 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.

As a Compliance and Ethics Investigator, Consultant, you will perform confidential internal investigations into allegations of misconduct, including sensitive matters related to fraud, violations of our Code of Conduct and corporate policies, conflicts of interest, misuse of company assets, and other legal, compliance, and regulatory concerns.

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 who are energized by creative and critical thinking, building and sustaining high-performing teams, getting results in the right way, and fostering continuous learning.

Responsibilities

Your Work

In this role, you will:
  • Conduct thorough internal investigations of reported Compliance and Ethics issues including, but not limited to, misconduct, fraud, conflicts of interest, misuse of company assets, and other legal or regulatory concerns.
  • Develop and execute investigation plans, identifying key witnesses, documents, and systems for evidence collection, and preserve and organize investigation artifacts.
  • Conduct fact-finding interviews, obtain and review documentation, analyze data, and write factual investigation reports.
  • Maintain accurate, timely, complete case documentation in the case management system and ensure closure summaries meet program standards.
  • Present investigation findings to key stakeholders including Employee Relations, operational management, and leadership.
  • Identify root cause, recommend corrective actions, and track those actions to completion with the responsible business areas.
  • Collaborate with subject matter experts in Privacy, Legal, IT and IT Security, Corporate Security, Internal Audit, and regulatory compliance teams with respect to identified compliance issues.
  • Handle matters where no established policy, regulation, or precedent applies, escalating as appropriate and recommending process or policy improvements when gaps are identified.
  • Safeguard the confidentiality of reporters to the extent possible and monitor for retaliation against individuals who raise concerns or participate in investigations.
  • Independently manage a caseload of concurrent matters of varying complexity and sensitivity, meeting established timeliness and quality standards.
  • Assist in the development and implementation of risk assessment, risk mitigation, and program improvement activities
  • Actively promote a culture of ethics, compliance, and "speak up" across the organization.


Qualifications

Your Knowledge and Experience
  • Requires a bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
  • Requires 7 years of prior relevant experience in health care compliance, legal services, privacy, investigative services, or a related field
  • Requires deep and current knowledge of healthcare compliance legislation and regulations
  • Requires experience with Excel including the ability to create pivot-tables and use formulas and functions to perform analytics
  • Requires experience conducting internal investigations within a corporate or public entity
  • Requires experience working with senior leaders through investigations
  • Requires the ability to translate sensitive, complex investigation findings to diverse audiences
  • Requires experience managing multiple priorities and consistently meeting deadlines in a dynamic environment
  • Ability to exercise sound, independent judgment and operate effectively in ambiguous situations where policy, regulation, or precedent does not provide clear direction.
  • Certified in Healthcare Compliance (CHC) or Certified Compliance and Ethics Professional (CCEP) certification, or the ability to obtain certification within two years of employment, is preferred.


Our Workplace Model:

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
  • For most teams, this means coming into the office two days per week.
  • Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
  • For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

About Blue Shield Of California

Blue Shield of California is a not-for-profit health plan provider that has been providing Californians with access to high-quality healthcare for over 80 years. The company offers a range of health insurance products and services to individuals, families, and employers. Blue Shield of California is committed to improving the health and wellbeing of its members and the communities it serves. The company is also committed to sustainability and has implemented a number of initiatives to reduce its environmental impact.
Learn more about Blue Shield Of California
Size
7,000 employees
Industry
Founded
1981

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