Operations Specialist, Consultant
4 weeks ago
Your Role
The Commercial Appeals and Grievances team performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. The Commercial Appeals and Grievances Operations Specialist – Consultant will report to the Commercial Appeals and Grievances Senior Manager. In this role, you will be responsible for supporting the business by reviewing inventory, identifying trends, deciding on a course of action to reduce member abrasion, and partnering with business units throughout the company to drive change. Additionally, you will be responsible for representing the department on any current and future mandates to ensure compliance is established and maintained. This position supports the leadership team with identifying opportunities for improvement, motivating staff, and developing constructive relationships with a diverse group of cross-functional business partners.
Your Work
In this role, you will:
- Act as a lead subject matter expert to review operational workflows of highest-level complexity and/or for multiple departments, identifying problems and developing improvements, modifications, and enhancements
- Lead the development and enhancement of tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff
- Provide leadership in tracking and communicating workflow and system changes to appropriate sources and coordination of training and documentation needs
- Develop and generate reports ranging from routine to complex for management review
- Participate as a subject matter expert in the development of written guidelines and documents problems as needed
- Provide leadership and manage all current and future mandates to ensure the department is compliant
- Conduct root cause analysis of incoming receipts, identify issues causing member abrasion, make recommendations to drive changes, work with cross-functional business partners to correct errors to reduce member abrasion
- Support leadership team through current and future system changes and enhancements
- Create and present presentations ranging from routine to complex for executives and leadership
- Provide guidance, coaching and training to other employees within job area
Your Knowledge and Experience
- Requires a bachelor’s degree or equivalent experience
- Requires at least 7 years of prior relevant experience
- Excellent presentation design, speaking, analytical and problem-solving skills
- Requires deep knowledge of job area typically obtained through advanced education combined with experience
- Typically viewed as a specialist within discipline, may have broad knowledge of project management
- Appeals and Grievances experience preferred
- Experience with healthcare mandates/implementation memos experience preferred
Pay Range:
The pay range for this role is: $ 96,500 to $ 144,800 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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