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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