Experienced Operations Coordinator
2 weeks ago
Your Role
The Commercial Appeals and Grievances team is dedicated to conducting thorough investigations concerning member complaints, appeals, and grievances. The Experienced Operations Specialist will report directly to a Supervisor within the Commercial Appeals and Grievances department. In this capacity, you will collaborate with the leadership team to ensure that all Desk Level Procedures (DLPs) are maintained and accurate. Your responsibilities will include supporting the leadership team in areas such as compliance, quality assurance, production metrics, workflow optimization, process enhancements, employee engagement, and fostering relationships with a diverse array of cross-functional partners.
Your Responsibilities
In this position, you will:
- Serve as a subject matter expert, reviewing operational processes, identifying issues, conducting root cause analyses, and proposing improvements and modifications.
- Manage databases essential for business operations.
- Create and assess tools and resources that boost operational efficiency, accuracy, and the technical skill levels of team members.
- Generate and present reports for management review; alert relevant department managers regarding issues in operational workflows that require immediate attention.
- Act as a subject matter expert in the formulation of written guidelines and document issues as necessary.
- Assist the leadership team with current and upcoming system changes and enhancements.
- Organize and promote employee engagement initiatives.
- Perform additional tasks as required.
Your Knowledge and Experience
- A bachelor's degree or equivalent experience is required.
- A minimum of 3 years of relevant experience is necessary.
- At least 1 year of experience in Appeals & Grievances is required.
- Knowledge of the job area typically gained through experience is essential.
- Exceptional attention to detail, analytical abilities, communication skills, and problem-solving capabilities are required.
- Ability to work independently and consistently meet deadlines is crucial.
- Note: Placement may occur in a specialty client or other unit.
The compensation range for this position is: $66,800 to $93,400 for California.
About the Team
Blue Shield of California is committed to ensuring that all Californians have access to high-quality healthcare at a sustainably affordable price. We are transforming healthcare to genuinely serve our nonprofit mission by reducing costs, enhancing quality, and improving the member and physician experience. To achieve our mission, we must cultivate a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meeting the needs of the multifaceted communities we serve. Our ongoing commitment to diversity, equity, and inclusion reflects 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 into our products and business practices.
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