A Career of Your Calling

The Impact You Will Have

Blue Cross Blue Shield of Minnesota is hiringa Directorof Compliance Oversight and Improvement in Eagan, MN.At Blue Cross Blue Shieldof Minnesota, compliance is acornerstone of our mission to serve members and partners with integrity. The Director of ComplianceOversight and Improvementleadsa teamof highly skilled compliance professionals, driving proactive risk management, audit readiness, and continuous improvementacross all lines of business. This leader is accountable for oversight of internal operations, First Tier, Downstream, and Related Entities (FDRs), vendors, and external regulatory audits, while fostering a culture of accountability and ethical conductacross every level ofthe organization.

The ideal candidate brings 7+ years of healthcare compliance experience and 5+ years ofpeopleleadership experience. You have deepexpertisein CMS, NCQA, and regulatory compliance across Medicare, Medicaid, and Commercial programs, including audits, filings, vendor oversight, andcorrective action plans. Youhave proven experiencetostrategicallyaligncompliance efforts at the enterprise level and clearly communicate complex risks to executives, boards, and regulators while leading with integrity and accountability.

Key Responsibilities

• Lead monitoring and assessment of internal operations, FDRs, and subcontractors, includingongoing vendor oversight.

• Develop and execute a comprehensive compliance monitoring and auditing strategy aligned with regulatory requirements and organizational risks.

• Use data analytics and trend analysis to detect emerging compliance risks.

• Act asthe primaryownerof accountability for all external regulatory audits (Centers for Medicare and Medicaid (CMS), state insuranceregulatory authorities).Lead the coordination ofaudit preparation, responses, deliverables, communications, and escalation management across impacted teams.

• Ensure timely and accurate submission of documentation and evidence to regulatory bodies.

• Oversee the development, approval, and validation ofCorrective Action Plans (CAPs), andmaintainreal-time dashboards and prepareregularupdates forexecutive leadership.Ensure CAPs are risk-appropriate, measurable, sustainable, and address root causes to prevent recurrence.

• Prepare and presentaccurate,timelyreporting and documentation for enterprise leadership, Board of Directors, and regulators, ensuring quality and transparency.

• Mentor, develop, and manage a high-performing team of audit and compliance professionals, promoting accountability, collaboration, and continuous learning.

• Partnerand collaboratewith operational leaders, procurement, legal, and business units to embed compliance into processes, serve as a compliance SME, and provide guidance and training.

• Champion complianceeffortsacross the enterprise,modelingthe highest standards ofintegrity and ethical conduct.

• Maintain strict confidentiality of all audit and compliance information, modeling ethicalconductand reinforcing enterprise compliance standards.

Required Skills and Experience

• Acceptance of this role requires signing an Employee Confidentiality, Intellectual Property Assignment, and Restrictive Covenants Agreement.

• Minimum of7 years ofrelated andprogressive experience in compliance, regulatory affairs, risk management, or legal roles within healthcare, insurance, or other highly regulated industries.All relevant experience including work, education, transferable skills, and military experience will be considered.

• At least5 years in a leadership or people management role, with proven ability to leadand developcross-functional teams and manageothermanagers.

• Experience in healthcare compliance, managed care, or insurance environments.

• Deep knowledge of federal, state, and industry regulations (e.g., CMS,National Committee for Quality Assurance (NCQA))and best practices for compliance programs.

• Demonstrated experience with Medicare, Medicaid, and Commercial programs, including regulatory filings, audits, and vendoroversightmanagement.

• Strong analytical, organizational, and problem-solving skills; ability to conduct risk assessments and developcorrective action plans.

• Exceptional written and oral communication skills, including the ability to present complex compliance issues to senior leadership and external regulators.

• Strategic, enterprise-wide thinking; positive, energized presence; strong teacher and problem solver;excellent delegator and escalator.

• Proficiencyin compliance platforms, reporting dashboards, andother modern workplace tools, including AI.

• Capacity to expand and evolve current processes to meet future needs; ability tofacilitatechange and leadthrough ambiguity.

• Commitment to fostering a culture of integrity, accountability, and compliance.

• Willingness to travel as needed for audits, training, or regulatory meetings.

• High school diploma (or equivalency) and legal authorization to work in the U.S.;must be eligible to work in the United States without need for work visa or residency sponsorship.

Preferred Qualifications

• Bachelor’s degree or higher in business, healthcare administration, public health, law, ora relatedfield.

• Health insurance industry experience.

• Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), or similar credential preferred;Continuing education in compliance, regulatory affairs, or risk management.

• Proventrack recordin developing, implementing, andvalidatingCAPs.

• Experiencecreating materials andpresentingto boards, compliance committees, or regulatory bodies.