Hiring: Government Programs Compliance Lead Company: Blue Cross Blue Shield Association Location: Chicago, IL Job Posted Time: 2026-09-10 11:51:02 Target Skills & Keywords : Embedded Systems, Medicare About the job Experience: •Required 7+ Years Qualifications: •Deep knowledge of CMS Medicare regulations and guidance (including 42 CFR Parts 422/423, CMS manuals, HPMS guidance, and audit protocols) •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 •Demonstrated capacity to conduct regulatory gap analyses and translate requirements into actionable controls across operational functions (e.g., claims, UM/CM, network, enrollment) •Strong auditing and monitoring capabilities including development of work plans, identification of compliance risks, and use of data-driven oversight •Demonstrated capacity to design, implement, and evaluate corrective action plans (CAPs) ensuring timely remediation and sustainable compliance outcomes Knowledge of CMS audit processes and audit-readiness expectations including document production, universes, and issue remediation lifecycle •Demonstrated capacity to interpret and apply regulatory requirements to complex business scenarios and provide practical, risk-based compliance guidance to operational stakeholders Strong governance and reporting skills including experience supporting compliance committees, senior leadership reporting, and Board-level oversight •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 Compensation: •This job is also eligible for annual bonus incentive pay Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!