Operations Supervisor

4 days ago


El Dorado Hills, California, United States Blue Shield of CA Full time
Your Role
The Commercial Appeals & Grievances department at Blue Shield of CA performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. As a Commercial Appeals & Grievances Supervisor, you will be accountable for hiring, promoting, coaching, and daily supervision of Commercial Appeals & Grievances coordinators as they review, investigate, and process member appeals and grievances. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work
In this role, you will:
1. Be responsible for routine operations and people management functions
2. Foster a great place to work by communicating clear roles and responsibilities and building successful working relationships across the organization
3. Consult and make recommendations to management on operational issues
4. Use concepts and abilities to manage processes and operations, including procedural changes, inventories, and workload management
5. Apply policies and procedures within healthcare operations
6. Stay up to date on legislation and regulations to ensure team compliance
7. Interpret audit information requests, prepare narratives, conduct preliminary risk assessments, anticipate adverse findings to prepare for internal corrective action plans
8. Make decisions on people and operational matters consistent with goals and objectives
9. Provide coaching, performance management, skill development, and guidance on team members' Professional Development Plans
10. Perform other related duties as assigned

Your Knowledge and Experience
Requires a High School Diploma or GED
Requires a minimum of 5 years of prior relevant experience
Requires a minimum of 2 years of experience operating in a lead role or equivalent leadership training or manager training
Requires related experience and/or training, or equivalent combination of education and experience. Must have experience in appeals and grievances and preferred experience in claims, customer service, installation & billing, or member services role in the healthcare industry.
Appeals and Grievances experience required
Understands basic supervision/management approaches such as work scheduling, prioritizing, coaching and process execution
Requires broad knowledge of technical or operational practices within assigned discipline
Commercial healthcare experience preferred
Must be willing to work weekends and holidays as needed


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