Bcbsa
Government Programs Compliance Lead
US IL Chicago E
Sponsorship not specified$114k-$154kDetected 19 days ago
ComplianceAuditingPharmacy PracticeLeadershipCommunicationProblem SolvingClaims Management
About the role
- We may ultimately pay more or less than the hiring range and t his hiring range may also be modified in the future.
Responsibilities
- Support ongoing risk assessment activities, incorporating insights from audits, FDR monitoring, and committee reporting to continuously enhance compliance program effectiveness and proactively address emerging regulatory risks
- Support the Medicare Compliance Officer in the execution and continuous improvement of the compliance program, ensuring alignment with CMS requirements and the 7 elements of an effective compliance program, with a focus on proactive risk identification and mitigation.
- Partner with operational and business teams to translate Medicare regulatory requirements into actionable, operational processes, ensuring compliance is embedded into workflows across key operational functions
Requirements
- Required 7+ Years
- Understanding of the 7 Elements of an Effective Compliance Program and ability to operationalize them across Medicare Advantage and Part D programs
- Knowledge of Medicare Part D and/or MA-PD program requirements including enrollment, claims, formulary, pharmacy operations, and member protections
- Knowledge of Fraud, Waste, and Abuse (FWA) requirements and detection methodologies including exclusion screening, investigations, and reporting obligations
- Ability to conduct regulatory gap analyses and translate requirements into actionable controls across operational functions (e.g., claims, UM/CM, network, enrollment)
- Effective communication skills with the ability to translate regulatory requirements into clear guidance, training, and business-friendly language
- Knowledge of privacy, data governance, and handling of sensitive information particularly as it relates to Medicare data and compliance investigations
- Strong analytical and problem-solving skills with the ability to identify root causes of compliance issues and recommend sustainable solutions
- High level of professional integrity and judgment including the ability to identify, escalate, and address potential compliance risks or noncompliance
Nice to have
- Experience supporting EGWP plans is strongly preferred
Skills
- Deep knowledge of CMS Medicare regulations and guidance (including 42 CFR Parts 422/423, CMS manuals, HPMS guidance, and audit protocols)
- Knowledge Skills and Abilities:
Compensation
- The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.
This listing is sourced directly from Bcbsa's careers page and normalized into a canonical job model.