Senior Compliance Advisor – State Health Plan

Blue Cross NC

. Lead day-to-day activities required to maintain an effective compliance program for State Health Plan operations and health plan administration .

Posted 10/28/2026full-timeDurham • North Carolina • United StatesSenior💰 $81,068 - $129,708 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in healthcare compliance, including NCQA accreditation standards and regulatory requirements, while effectively managing compliance programs and cross-functional initiatives. Capable of translating complex regulatory requirements into operational guidance and training for diverse stakeholders.

Highest-signal resume keywords

Healthcare ComplianceNCQA Accreditation StandardsCase ManagementUtilization ManagementRegulatory Affairs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Compliance AuditsRisk AssessmentsCorrective Action PlansOperational ControlsRegulatory Requirements AnalysisQuality Improvement PlansBehavioral Health Parity ComplianceContractual Obligations ReviewClinical OperationsVendor Management

Soft Skills

Analytical SkillsCross-Functional LeadershipInfluenceStrong JudgmentCommunication

Industry Keywords

Health Plan OperationsNorth Carolina Department of InsuranceERISAMHPAEACompliance Metrics

About the role

Key responsibilities & impact

Lead day-to-day activities required to maintain an effective compliance program for State Health Plan operations and health plan administration
Coordinate complex, cross-functional matters involving physical and behavioral health benefits, Case Management, Utilization Management, delegated entities, vendors, and clinical operations
Identify compliance risks and interpret and operationalize applicable requirements
Develop or facilitate corrective action plans
Conduct audits and compliance reviews to monitor adherence to NCQA standards, North Carolina Department of Insurance requirements, ERISA, MHPAEA, contractual obligations, and applicable laws and regulations
Resolve complex, enterprise-wide compliance questions affecting SHP benefits, operations, clinical programs, and vendor relationships
Serve as a compliance subject matter expert for physical and behavioral health Case Management and Utilization Management
Research changing requirements and translate them into operational guidance, policies, controls, and implementation plans
Advise business leaders on compliance implications and practical solutions
Partner with SHP leadership, Legal, Clinical, Case Management, Utilization Management, Behavioral Health, Appeals and Grievances, Network, Benefits, Operations, Vendor Management, and other stakeholders
Conduct risk assessments, audits, and compliance reviews of processes, programs, systems, vendors, and delegated entities
Monitor compliance metrics and emerging risks and validate corrective and preventive actions
Assist with quality improvement plans, root cause analysis, targeted training, remediation, and progress tracking
Evaluate MHPAEA and parity compliance across physical and behavioral health programs
Support SHP readiness for NCQA surveys and regulatory or accreditation reviews
Lead analysis of the enterprise and SHP regulatory environment and recommend compliance programming, monitoring, governance, and risk mitigation initiatives
Develop training, tools, and communications for employees, leaders, vendors, and delegated entities
Review policies, procedures, workflows, clinical documents, contracts, benefit booklets, plan documents, and marketing and member-facing materials for compliance
Provide coaching and technical guidance to less experienced team members and coordinate work across compliance initiatives

Requirements

What you’ll need

Bachelor's degree or advanced degree (where required)
5+ years of experience in related field
In lieu of degree, 7+ years of experience in related field
Substantial experience in healthcare compliance, health plan operations, clinical operations, regulatory affairs, accreditation, or a related field
Demonstrated understanding of Case Management and Utilization Management roles, responsibilities, workflows, documentation, and regulatory requirements across physical and behavioral health
Working knowledge of NCQA accreditation standards, North Carolina Department of Insurance requirements, ERISA, MHPAEA and related behavioral health parity requirements, including comparative analyses of nonquantitative treatment limitations, and other federal and state requirements applicable to SHP
Experience assessing delegated entities, vendors, or clinical programs and translating regulatory requirements into sustainable operational controls
Ability to evaluate complex issues through clinical, regulatory, operational, and member-impact lenses and communicate recommendations to executive and operational audiences
Strong judgment, analytical skills, influence, and cross-functional leadership, with the ability to manage multiple high-risk priorities in a complex healthcare environment

Benefits

Comp & perks

Annual Incentive Bonus based on annual corporate goal achievement and individual performance
401(k) with employer match
Paid Time Off (PTO)
Competitive health benefits
Wellness programs
Robust Total Rewards package