Operations Specialist, Consultant

4 weeks ago


El Dorado Hills, United States Blue Shield of California Full time

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.
 
 
#LI-CP3



  • El Dorado Hills, United States Blue Shield Of California Full time

    Your Role The IT Communications team develops and delivers compelling and informative communications that engage, inform and inspire employees to achieve the companys goal of transforming healthcare. We amplify IT's value as a trusted partner and reinforce the importance of technology as a driver to change the industry. The Internal Communications...


  • United States, CA, El Dorado Hills Blue Shield of California Full time

    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...


  • El Dorado Hills, United States Blue Shield of CA Full time

    Your Role The Privacy Office develops and oversees Blue Shield's Privacy Program. The Privacy Program ensures that Blue Shield and its affiliated covered entities, including Blue Shield of California Promise Health Plan, are in compliance with state and federal privacy laws and regulations, including the Health Insurance Portability and Accountability Act of...


  • El Dorado Hills, California, United States Army National Guard Full time

    Job Title: Combat Operations SpecialistJob Summary: We are seeking a highly skilled Combat Operations Specialist to join our team at the Army National Guard. As a member of our team, you will be responsible for conducting combat operations, including reconnaissance, mine operations, and communication equipment maintenance.Key Responsibilities:Assist in...


  • El Dorado Hills, United States Blue Shield of CA Full time

    Your Role The IT Service Management Incident Management team's activities consider the availability, reliability, maintainability, scalability, performance, and serviceability at both service and component level of IT Services. The roles within the team are focused by business domain, to provide direct linkage and knowledge between IT customers (BSC business...


  • el dorado hills, United States Aditi Consulting Full time

    Experience troubleshooting O365 Apps, internet browsers, Networks, VPNs, Operating systems, etc.Troubleshoot issues related to Laptop/Desktop, Printers, Active Directory, and other IT applications.Configure, deploy, and support various computers, networking, phones, mobile devices, audio-video, and other equipment and software related to the end-user...


  • el dorado hills, United States Aditi Consulting Full time

    Experience troubleshooting O365 Apps, internet browsers, Networks, VPNs, Operating systems, etc.Troubleshoot issues related to Laptop/Desktop, Printers, Active Directory, and other IT applications.Configure, deploy, and support various computers, networking, phones, mobile devices, audio-video, and other equipment and software related to the end-user...


  • El Dorado Hills, United States Blue Shield of CA Full time

    Your Role The Internal Auditor Consultant will report to the Internal Audit Senior Director. In this role you will be responsible for providing objective examinations of evidence for providing independent assessment to the Audit Committee, management and outside parties on the adequacy and effectiveness of governance, risk, management and control processes....


  • El Dorado Hills, United States Blue Shield of CA Full time

    Your Role The Reporting, Analysis and Administration team supports Blue Shield of California with design, development, and management of Verint, Genesys and Avaya platforms. We provide business support expertise and manage requirements deliverables. Currently, this includes Routing, Quality, Speech, WFM, Performance Management and Desktop Analytics modules....


  • el segundo, United States Specialist Direct Full time

    About Specialist DirectFounded in 2015, Specialist Direct (SDI) is the number one, fastest growing organ transplant telehealth company in the US. Our award-winning, cloud-based diagnostic solutions have been instrumental in improving organ utilization and increasing organ placements. With a national network of top specialists, SDI delivers more accurate...


  • El Dorado Hills, California, United States Blue Shield of CA Full time

    Your RoleThe Reporting, Analysis and Administration team at Blue Shield of California supports the design, development, and management of Verint, Genesys, and Avaya platforms.We provide business support expertise and manage requirements deliverables.Currently, this includes Routing, Quality, Speech, WFM, Performance Management, and Desktop Analytics...

  • PC Support Specialist

    1 month ago


    El Dorado Hills, California, United States Blue Shield Of California Full time

    About the RoleWe are seeking a highly skilled PC Technician Support Specialist to join our Technology Services and Operations team. As a Technical Support Specialist, you will play a critical role in supporting all end point systems and technology, providing exceptional customer experience, and contributing to the growth and development of our team.Key...

  • Operations Supervisor

    4 weeks ago


    El Dorado Hills, California, United States Blue Shield of CA Full time

    Your RoleThe Commercial Appeals & Grievances department at Blue Shield of CA performs comprehensive research related to member complaints, appeals, and grievances. As a Commercial Appeals & Grievances Supervisor, you will be accountable for hiring, promoting, coaching, and daily supervision of coordinators as they review, investigate, and process member...

  • Operations Supervisor

    4 weeks ago


    El Dorado Hills, California, United States Blue Shield of CA Full time

    Your RoleThe Commercial Appeals & Grievances department at Blue Shield of CA performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. As a Commercial Appeals & Grievances Supervisor, you will be accountable for hiring, promoting, coaching, and daily supervision of Commercial Appeals & Grievances...


  • El Dorado Hills, United States Aditi Consulting Full time

    Experience troubleshooting O365 Apps, internet browsers, Networks, VPNs, Operating systems, etc.Troubleshoot issues related to Laptop/Desktop, Printers, Active Directory, and other IT applications.Configure, deploy, and support various computers, networking, phones, mobile devices, audio-video, and other equipment and software related to the end-user...


  • El Dorado Hills, United States Aditi Consulting Full time

    Experience troubleshooting O365 Apps, internet browsers, Networks, VPNs, Operating systems, etc.Troubleshoot issues related to Laptop/Desktop, Printers, Active Directory, and other IT applications.Configure, deploy, and support various computers, networking, phones, mobile devices, audio-video, and other equipment and software related to the end-user...

  • Supervisor, Operations

    3 months ago


    El Dorado Hills, United States Blue Shield of California Full time

    Your Role   The Commercial Appeals & Grievances department performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. The Commercial Appeals & Grievances Supervisor will report to the Commercial Appeals & Grievances Senior Manager. In this role, you will be accountable for hiring, promoting,...


  • El Dorado Hills, California, United States Blue Shield Of California Full time

    Job SummaryThe Technology Services and Operations team at Blue Shield Of California is seeking a skilled Technical Support Specialist to join our team. As a Technical Support Specialist, you will be responsible for assisting our customers with endpoint systems and technology.Key ResponsibilitiesProvide technical support to customers via phone, email, or...


  • El Dorado Hills, California, United States Broadridge Financial Solutions , Inc. Full time

    Job SummaryWe are seeking a highly skilled Client Operations Representative to join our team at Broadridge Financial Solutions, Inc. This role is responsible for providing exceptional client service, resolving issues, and ensuring seamless operations.Key ResponsibilitiesEfficiently complete tasks to support internal and external client needs.Act as a liaison...

  • Respiratory Therapist

    4 weeks ago


    El Dorado, Arkansas, United States South Arkansas Regional Hospital Full time

    Cardiopulmonary Specialist OpportunitySouth Arkansas Regional Hospital is seeking a skilled Respiratory Therapist to join our team. As a Cardiopulmonary Specialist, you will be responsible for providing high-quality patient care, including assessment, treatment, and diagnostic evaluation of patients with cardiopulmonary system deficiencies and...