Blue Shield of California

Compliance and Ethics Program Investigator, Consultant

Blue Shield of California  •  Oakland, CA (Onsite)  •  2 days ago
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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.

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.

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.
Blue Shield of California

About Blue Shield of California

Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with nearly 6 million members, over 7,500 employees and more than $25 billion in annual revenue.

Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $60 million to Blue Shield of California Foundation in the last three years to have an impact on California communities.

For more news about Blue Shield of California, please visit news.blueshieldca.com.

Industry
Finance & Insurance
Company Size
5,001-10,000 employees
Headquarters
Oakland, California
Year Founded
1939
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