Commercial Program Compliance Specialist, Consultant

Your Role

The Commercial Program Compliance team provides compliance oversight and validation of regulatory mandate implementation across the Commercial business, with a focus on assessing implementation effectiveness, identifying potential gaps, and supporting ongoing compliance and audit readiness. The Commercial Program Compliance Specialist, Consultant will report to the Senior Manager, Commercial Program Compliance. In this role you will support the development and execution of the Commercial mandate validation and oversight program, conduct evidence-based reviews of implemented requirements, and partner with cross-functional stakeholders to assess compliance effectiveness. You will also help strengthen and mature program processes, tools, reporting, and governance as the Commercial compliance program continues to evolve. 

Your Work

In this role, you will: 

• Execute and support the annual mandate validation and oversight program
• Review compliance artifacts to assess effectiveness of implemented mandates and controls
• Conduct independent audits of complex compliance issues and assess operational effectiveness
• Advise cross‑functional stakeholders on compliant solutions for newly enacted and revised mandates
• Identify execution gaps, recommend corrective actions, and support risk calibration with business units
• Prepare and deliver complex analyses and reports to senior management and oversight committees
• Support the development and continuous improvement of Commercial compliance validation processes, tools, procedures, and reporting.
• Research and analyze complex compliance topics to support program development, oversight activities, and informed decision-making.
• Build and maintain collaborative relationships with cross-functional business partners and subject matter experts to support effective compliance oversight.
• Other duties as assigned

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 a healthcare setting, 4 of which were in a regulatory change management related role
• Requires deep knowledge of regulatory compliance standards and processes
• Requires sound knowledge of and experience with the Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes and has demonstrated experience in working with mandates
• Requires demonstrated ability to develop, enhance, or operationalize compliance programs, processes, tools, or frameworks.
• Requires demonstrated ability to research complex compliance matters, analyze information from multiple sources, and develop clear, actionable recommendations and deliverables.
• Requires experience using compliance management systems, data tracking tools, or similar technology to support compliance oversight, documentation, and reporting.
• Requires excellent analytical and problem-solving skills
• Requires deep familiarity with compliance risk assessments and audits
• Requires proficiency in Microsoft Word, Access, Excel, PowerPoint and Outlook
• Professional healthcare compliance certifications (e.g., CHC – Certification in Healthcare Compliance) and/or advanced degree preferred.

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.