Manager, Operations
1 week ago
Your Role
The Appeals and Grievances team is responsible for resolving our members concerns through a regulated process which includes accurately, timely and compliantly addressing each of the members concerns. The Manager of Operations will report to the Senior Manager of Operations. In this role you will provide leadership and support to your team as well as interact with our members and specialty clients. You will also interact directly with our regulator, developing and presenting updates on case activity, discussing trends and observations as well as serving as a primary speaker for regulatory audit activity.
Your Work
In this role, you will:
Responsible for a singular team, department or functional area. Scope of oversight includes planning, cost management and methods
Demonstrate BSC Leadership Behaviors
Foster a great place to work by clearly communicating mission, vision, goals, roles, and expectations for team members; celebrating team achievements; building successful working relationships across the organization
Direct and control the activities of one or more smaller/less complex department(s) or functional area(s) through subordinate supervisors/team leads
Establish operational objectives for department or functional area and participates with other managers to establish group objectives
Ensure team processes are efficient and effective to manage case work timely and accurately
Improve quality results through training and oversight
Establish audit readiness across your team and in partnership with your peers
Trend top drivers of appeals and grievances, working with upstream and downstream partners to reduce member pain points
Responsible for making moderate to significant improvements in within the department, by partnering with training and other key stakeholders.
Your Knowledge and Experience
Requires a college degree or equivalent experience and minimum 7 years prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager
Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation
Understands Blue Shield of CA’s mission and business plan
Has functional expertise within the area of responsibility
Requires advanced knowledge of job area usually obtained through advanced education combined with experience
Strong knowledge of the Appeals and Grievances process
Experience interacting directly with healthcare regulators
Regulatory audit experience
Acumen to handle complex situations and multiple responsibilities simultaneously with the urgency of immediate demands on the operations
Ability to present information clearly and concisely to various audiences
Note: You may be placed in a specialty client, or other unit, such as CalPERs.
Pay Range:
The pay range for this role is: $ 96,500 to $ 144,800for 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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