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Operations Specialist, Experienced
2 months 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 - Experienced will report to a Commercial Appeals and Grievances Supervisor. In this role you will partner with the Commercial Appeals & Grievances leadership team by supporting the business with ensuring all Desk Level Procedures (DLPs) are up to date and accurate. You will be responsible for supporting the Commercial Appeals and Grievances leadership team with compliance, quality, production, workflow, process improvements, employee engagement and developing relationships with a diverse group of cross-functional business partners.
Your Work
In this role, you will:
- Act as subject matter expert and review operational workflows, identify problems, perform root cause analysis and develop improvements, modifications, and enhancements.
- Maintain databases required for business operations.
- Develop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff.
- Develop and generate reports for management review; notify appropriate department managers about issues and problems in operational workflow requiring immediate attention.
- Participate as a subject matter expert in the development of written guidelines and document problems as needed.
- Support leadership team through current and future system changes and enhancements.
- Create and support employee engagement activities.
- Other tasks as needed.
Your Knowledge and Experience
- Requires a bachelor's degree or equivalent experience
- Requires at least 3 years of prior relevant experience
- Requires at least 1 year of Appeals & Grievances experience
- Requires knowledge of job area typically obtained through experience
- Excellent attention to detail, analytical, communication and problem-solving skills
- Able to work independently and meet deadlines consistently
- Note: You may be placed in a specialty client, or other unit, such as CalPERs.
Pay Range:
The pay range for this role is: $ 66,800 to $ 93,400 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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