Senior Compliance Oversight Consultant - PBM

Job Duties

Senior Compliance Oversight Consultant - PBM

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll HaveThis position actively participates in the organizations compliance, risk management, and operational excellence. Through monitoring and assessment of internal operations and external partners (First Tier, Downstream, and Related Entities (FDRs)/Subcontractors), the role ensures adherence to regulatory and organizational standards. Through proactive compliance reviews, effective audit support, and corrective action initiatives, this role helps safeguard the organizations reputation and regulatory standing. The position may also oversee vendors, collaborating across departments and with external partners to embed compliance into daily processes to maintain readiness for regulatory review.What You'll Do

• Own ongoing monitoring of internal and external operations, and targeted deep dives into activities performed by Vendor Managers.

• Plan and execute internal and external compliance assessments.

• Provide guidance and support for external regulatory audits impacting a functional area and related FDR/subcontractors by offering regulatory insight reviewing documents and written responses prior to submission.

How You'll Do It

• Contribute to the development and validation of Corrective Action Plans (CAP), provide consultation, and collaborate with internal teams and/or FDR/Subcontractors on CAP implementation.

• Document, collect, and organize information into clear, accurate reports and maintain records and related documentation for reporting to the Enterprise Ethics and Compliance (EEC) Leadership, Blue Cross leadership, EEC Committee members, the Board of Directors, and external regulators.

• Support and assist in guiding and training junior staff involved in monitoring and assessment deliverables.

• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 5+ years of related compliance & regulatory affairs professional experience.

• Bachelors degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• Medicare Part D compliance experience.

• PBM/pharmacy operational knowledge.

• PBM/FDR oversight or PBM compliance experience.

• Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.

• Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.

• Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.

• Business analysis expertise, regulatory research, and ability to translate regulatory requirement into operation.

• Ability to interpret and apply applicable federal and state regulations.

• Healthcare or insurance industry experience.

• Experience with Medicare/Medicaid regulatory programs.

• Experience with CMS, DOH, and state regulatory filings.

• Experience drafting responses or presenting to boards, compliance committees, or regulatory bodies.

Licensure/CertificationsNice to Have:

Certified Compliance & Ethics Professional (CCEP) - Society of Corporate Compliance and Ethics (SCCE)

Certified Internal Auditor (CIA) - Institute of Internal Auditors (IIA)

Certified Public Accountant (CPA) - State Board of Accountancy

Certified in Healthcare Compliance (CHC) - Health Care Compliance Association (HCCA).Role DesignationHybrid

Role designation definition:

• Teleworking is working full time remote.

• Hybrid is a minimum of 2 days onsite.

• Onsite is full-time onsite.

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Compensation and Benefits$79,100.00 - $104,800.00 - $130,500.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance

• Life insurance

• 401k

• Paid Time Off (PTO)

• Volunteer Paid Time Off (VPTO)

• And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [email protected].

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements.

Apply Here: https://www.click2apply.net/5JGE5DSYpkPElCG7ASMJMR

PI288242598

Minimum Education Required

Bachelors degree

Minimum Experience Required

5+ years

Shift

First (Day)

Number of Openings

1

Compensation

$79,100.00 - $130,500.00 / Annually

Postal Code

55121

Job Type

Full Time

Place of Work

On-site

Requisition ID

110238

Job Benefits

Health Insurance