Senior Director, Compliance and Ethics

Your Role

This role will act as Blue Shield of California's (BSC's) Senior Director, Compliance & Ethics. BSC's Compliance & Ethics Department is part of BSC's larger Corporate Integrity and Risk Management. BSC Corporate Compliance & Ethics owns and coordinates the Company's compliance and ethics program across the enterprise, including all business units, products, services and activities. The Compliance & Ethics program 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 remediating control deficiencies.

The Compliance & Ethics program encompasses many subject matter areas, including Code of Conduct, Corporate Compliance policy management, compliance training, compliance investigations, anti-bribery, -kickback and -corruption, exclusion lists, Conflict of Interest program management, and other compliance and ethics initiatives. The role will report directly to BSC's Vice President, Chief Risk and Compliance Officer. While this role will spend most of its time leading our enterprise-wide Compliance & Ethics program, it may serve in additional capacities and assist in other initiatives, as needed.

Your Knowledge and Experience

• Bachelor's Degree and a minimum of 12 years of substantive health care legal, compliance and ethics experience with increasingly progressive responsibility including Director-level Compliance experience and 8 years of management/leadership experience required.
• Juris Doctor (JD) from an ABA accredited law school and admission to practice law in California is preferred.
• Functional subject matter expertise in Codes of Conduct, compliance investigations, compliance hotlines/reporting, compliance training and communications, anti-corruption/anti-bribery/anti-kickback, government contracting, exclusion lists, corporate ethics, business partner and third-party risk management, and applicable laws, regulations and standards including anti-fraud, anti-corruption, Federal Sentencing Guidelines, U.S. Department of Health, and Human Services (DHHS) Officer of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) guidance on effective compliance programs.
• Demonstrated experience with writing and implementing policies and procedures, performing risk assessments, documenting controls and control gaps, remediating control gaps, and delivering and maintaining a robust and effective compliance and ethics program.
• Must possess excellent verbal and written communication and relationship building skills to effectively interact with senior management team, board members, providers, and federal and state regulators. Strong independent judgment, problem-solving, critical, and analytical thinking skills, including a "moral compass" and high integrity.
• Certified Healthcare Certification (CHC) or Certified Compliance and Ethics Professional Certification (CCEP), and experience and knowledge of compliance or risk incident management software preferred.