At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
The Impact You Will HaveThis role provides strategic leadership and oversight for the Regional Medicare Prescription Drug Program (Part D), working with the Compliance Office to ensure compliance with CMS, contractual, and applicable state and federal requirements. The position serves as a trusted Medicare compliance advisor to internal leadership, vendors, and clients, with accountability for regulatory interpretation, audit readiness, and continuous improvement of the Part D compliance program.
The role is responsible for proactively identifying and mitigating compliance risk, leading CMS audit preparedness and response, overseeing First Tier, Downstream, and Related Entity (FDR) compliance, and translating complex regulatory requirements into practical, business‑aligned solutions.
Your ResponsibilitiesEstablish and maintain a strong and positive working relationship with external client representative(s).
Support client through: Advocating for client through research of internal systems, processes, policies and vendor data to identify root cause and determine appropriate resolution option(s); Providing on-going education, via written or verbal responses, to client to clarify our position regarding company policies and procedures; Serving as first contact and technical expert around client regulatory needs for leadership, internal team members and external client; Reviewing reports and identifying trends in issues impacting client performance and satisfaction; Working with other team members to identify root cause and recommend process and procedural changes to improve member experiences.
Develop, analyze, and provide feedback to processes and reports to oversee and monitor the regional activities to ensure compliance with CMS and contractual requirements.
Work with internal teams, regional vendors, and Alliance Plans to educate, train, and implement self-monitoring, audit and corrective action plans.
Establish and maintain a comprehensive understanding of all new and existing laws, regulations, and other requirements that impact our products and operations in order to provide guidance to analysts on implementation and other compliance strategies.
Manage the identification, interpretation, education, and implementation of Medicare and pharmacy-related regulations.
Review cross functional Policies and Procedures across the enterprise to ensure adherence to compliance requirements.
Ensure CMS required audits are prepared for and completed according to regulatory requirements using assessment tools and corrective action plans.
Develop and implement audit plans, self monitoring, and audit tools to monitor and track compliance.
Lead annual assessments of First-Tier, Downstream, or Related Entities (FDRs)
7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Experience in the health care industry with specific ethics/compliance program knowledge and experience in Medicare Part D Programs
Experience managing project(s) involving multiple team members and including task assignment, working with key customers (internal or external), managing team and/or customer relationships and managing project deliverables.
Detailed knowledge of the development of Government Programs Compliance plans, Medicare Advantage and Medicaid products.
Proven ability to work with CMS/State Regulators.
Knowledge of Health Plan operations on Pharmacy products including claims, enrollment, sales and marketing, health services and membership. ·
Fundamental knowledge of health insurance regulation at both federal and state levels. Proven experience in the development and implementation of corporate regulatory compliance and ethics programs.
Significant training experience including program development and implementation.
Well-developed analytical, problem-solving and communication skills. Business Analysis expertise and ability to translate regulatory requirements into operation.
In depth understanding and experience in application development and submission to the Federal Government on Medicare Products, Advanced understanding of Part D regulatory requirement.
High school diploma (or equivalency) and legal authorization to work in the U.S.
Bachelor’s degree
Anchored in Connection
Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.
Compensation and Benefits$102,400.00 - $138,300.00 - $174,200.00 AnnualPay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical, dental, and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer, please review our benefits page.
Equal Employment Opportunity StatementAt Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [email protected].
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Skills Required
- 7+ years of related professional experience
- Experience in the healthcare industry with Medicare Part D programs
- Proven ability to work with CMS/State Regulators
- Significant training experience including program development
- High school diploma or equivalent
Blue Cross and Blue Shield of Minnesota Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Blue Cross and Blue Shield of Minnesota and has not been reviewed or approved by Blue Cross and Blue Shield of Minnesota.
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Retirement Support — The program combines a 401(k) match with additional company retirement contributions and a cash balance pension. This multi-pronged design strengthens long-term financial security beyond standard offerings.
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Parental & Family Support — Benefits include fully paid parental leave, adoption/surrogacy/foster assistance, and childcare support. These resources provide meaningful support across diverse family needs.
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Leave & Time Off Breadth — PTO that increases with tenure, multiple paid holidays, personal days, and paid volunteer time are paired with flexible scheduling. This breadth supports sustained work-life balance across career stages.
Blue Cross and Blue Shield of Minnesota Insights
What We Do
Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives. Chartered in 1933 as Minnesota’s first health plan, we’ve promoted wider, more economical and timely availability of health services for the people of Minnesota for 80+ years. Blue Cross® and Blue Shield® of Minnesota is a nonprofit independent licensee of the Blue Cross® and Blue Shield® Association.
