Hybrid Program Coordinator, Experienced- (Operations Audit Oversight) bei Blue Shield of California Group
Blue Shield of California Group · El Dorado Hills, Vereinigte Staaten Von Amerika · Hybrid
- Professional
- Optionales Büro in El Dorado Hills
Your Role
The Operations Audit Oversight team partners with external audit firms, regulators, and internal stakeholders to ensure compliance through robust audit execution and oversight across the Claims Organization. The team supports required audits, conducts data-driven claim reviews, identifies root causes, and proactively strengthens operational integrity. The Program Coordinator, Experienced will report to the Senior Manager, Claims. In this role, you will contribute to critical oversight and regulatory alignment by supporting MHPAEA (Mental Health Parity and Addiction Equity Act) monitoring efforts. To help ensure claims meet parity standards, collaborate with internal teams to evaluate compliance, and drive initiatives that support fair and equitable access to behavioral health services.
Responsibilities
Your Work
In this role, you will:
- Be responsible for strategic alignment and integration across projects/programs, from initiation through delivery, in support of business unit process and administrative efficiency
- Define projects required to support programs and partners to ensure their implementation on time, within budget and with benefits realized
- Participate cross-functionally in business planning to support business unit strategy
- Be responsible for large/complex projects/programs
- Exercise independent judgement in developing methods, techniques and evaluation criterion for obtaining results
Manage compliance monitoring efforts related to MHPAEA regulations and ensure claims are aligned with parity standards
Lead the revision of policies and procedures in response to regulatory changes and support training initiatives across teams
Oversee internal and external data reporting to track parity compliance, claims performance, and audit outcomes
Collaborate across departments to resolve claims discrepancies and identify systemic opportunities for improvement
Analyze claims data to proactively identify patterns and prevent future MHPAEA-related issues[MM1]
Qualifications
Your Knowledge and Experience
Requires a bachelor’s degree or equivalent experience
Requires at least 3 years of prior relevant experience
Requires excellent communication skills with the ability to translate mental health parity and claims concepts for varied audiences
Requires proficiency in MS Office applications, especially Excel, to perform data-driven claims analysis
Working knowledge of Facility and Professional behavioral health claims processing and experience with the FACETS system preferred
Desired experience with reporting tools such as Business Objects or similar platforms[MM1]
Desired understanding of mental health benefit structures and parity-related requirements
Desired ability to adapt to shifting priorities and contribute effectively in a dynamic environment
About Company
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
- Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:
o Member-facing and approved out-of-state roles remain remote.
o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
- On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
