Operations Management Specialist

4 days ago


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

Company Overview:
Blue Shield of California is a leading healthcare organization dedicated to providing exceptional service and support to its members. Our Commercial Appeals & Grievances department plays a vital role in ensuring that our members receive fair and timely resolutions to their complaints, appeals, and grievances.

Salary:
The estimated annual salary for this role is $76,700-$114,500, based on experience and location within California.

Job Description:
As a Commercial Appeals & Grievances Supervisor, you will be responsible for managing the daily operations of our team, including hiring, promoting, coaching, and supervising coordinators as they review, investigate, and process member appeals and grievances. You will also manage projects and participate in regulatory audit activities.

Key Responsibilities:

  • Manage routine operations and people management functions
  • Foster a positive work environment by communicating clear roles and responsibilities and building successful working relationships across the organization
  • Consult and make recommendations to management on operational issues
  • Use analytical skills to manage processes and operations, including procedural changes, inventories, and workload management
  • Apply policies and procedures within health care operations
  • Stay up-to-date on legislation and regulations to ensure team compliance
  • Interpret audit information requests, prepare narratives, conduct preliminary risk assessments, anticipate adverse findings to prepare for internal corrective action plans
  • Making decisions on people and operational matters consistent with goals and objectives
  • Provide coaching, performance management, skill development, and guidance on team members' Professional Development Plans

Required Skills and Qualifications:
To succeed in this role, you will need a High School Diploma or GED, a minimum of 5 years of prior relevant experience, and at least 2 years of experience operating in a lead role or equivalent leadership training or manager training. You must also have experience in appeals and grievances and preferred experience in claims, customer service, installation & billing, or member services role in the health care industry.

Benefits:
As a valued employee of Blue Shield of California, you will enjoy a comprehensive benefits package, including competitive pay, medical, dental, and vision coverage, retirement savings plan, paid time off, and more.



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