Senior Manager Operations-CalPERS
5 days ago
We are seeking a highly skilled Senior Manager to lead our Appeals and Grievances team at Blue Shield of California. As a key member of our operations team, you will be responsible for resolving member concerns through a regulated process, ensuring accurate, timely, and compliant addressing of each concern.
Key Responsibilities- Lead multiple teams, departments, or functional areas, driving results aligned with planning, cost management, and methods.
- Foster a great work environment by clearly communicating mission, vision, goals, roles, and expectations for team members, recognizing top talent and team achievements, building successful working relationships across the organization, ensuring a safe and healthy work environment, and delivering the tools, time, and talent needed to succeed.
- Own budget management, resource management, process improvements, and technology changes for the team(s), department(s), or functional area(s) within your purview.
- Develop and implement annual budgets.
- Manage several related projects, often with the intention of improving the organization's performance.
- Manage internal and regulatory audit activity.
- Drive quality improvement and efficiency in processes.
- Monitor case activity, ensuring timeliness and accuracy of all work.
- 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 the department by partnering with training and other key stakeholders.
- Requires a bachelor's degree or equivalent experience.
- Requires at least 10 years of prior relevant experience, including 4 years of management experience.
- Direct experience with Appeals and Grievances is required.
- Regulatory audit experience is preferred.
- Ability to build strong and sustainable relationships and the capability to interact with all levels of the organization.
- 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.
Blue Shield of California's mission is to ensure all Californians have access to high-quality healthcare at a sustainably affordable price. We are transforming healthcare in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
We are committed to creating a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
We have received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving.
We strive to make a positive change across our industry and communities - join us.
Our Values- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
We offer two ways of working: Hybrid and Office.
- Hybrid - In a business unit-approved office a few times per week, on average.
- Office - In a business unit-approved office 4+ days a week, on average.
Office Environment - roles involving part to full-time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of the workday.
Please click here for further physical requirement detail.
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