Blue Shield Of California

Program Manager, Principal

Blue Shield Of California$120K — $145K *
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree or equivalent experience
  • Minimum of 10 years in healthcare finance, program management, compliance, actuarial, consulting, or managed care
  • Knowledge of Medi-Cal managed care, healthcare finance, and regulatory compliance
  • Ability to interpret complex regulations and provide actionable recommendations
  • Strong executive communication and stakeholder management skills

Responsibilities

  • Lead financial compliance activities for Medi-Cal regulations and audit readiness
  • Evaluate new regulatory requirements and assess impacts
  • Consult with senior management to support decision-making
  • Identify business issues and develop actionable solutions
  • Drive improvements in processes and policies to enhance financial controls
  • Partner across departments and represent the organization with external stakeholders

Benefits

  • Hybrid work model with in-office collaboration
  • Flexibility based on business needs for remote workers
  • Opportunity to influence financial strategies and compliance standards
Full Job Description
Job Description

Your Role

The Medi-Cal Actuarial and Finance Analytics team is responsible for rate development, financial oversight, regulatory compliance, and strategic financial analysis. The Program Manager, Principal will report to the Senior Director of Medicare and Medi-Cal Finance Analytics. In this role you will serve as a subject matter expert supporting financial compliance, delegated provider oversight, and regulatory requirements.

Responsibilities

Your Work

In this role, you will:
  • Lead financial compliance activities related to Medi-Cal regulations, delegated provider oversight, Medical Loss Ratio reporting, and audit readiness
  • Independently evaluate new regulatory requirements, assess financial and operational impacts, and develop recommendations for leadership
  • Consult with and influence all levels of the organization, including senior management, to support strategic and regulatory decision-making
  • Identify key business issues, develop actionable solutions, and drive implementation to achieve successful outcomes
  • Drive process and policies improvements that strengthen financial controls, reduce compliance risk, and enhance regulatory reporting accuracy and timeliness
  • Partner across departments and represent the organization in engagements with external stakeholders


Qualifications

Your Knowledge and Experience
  • Requires a bachelor's degree or equivalent experience
  • Requires a minimum of 10 years of prior relevant experience in healthcare finance, program management, compliance, actuarial, consulting, or managed care
  • Knowledge of Medi-Cal managed care, healthcare finance, and regulatory compliance
  • Demonstrated ability to independently interpret complex regulations and translate requirements into actionable business and financial recommendations
  • Strong executive communication and stakeholder management skills, including experience representing organizations with regulators, health plans, providers, and external partners

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

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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