JOB DESCRIPTION
Your Role

The Appeals and Grievances team is responsible for resolving our members concerns through a regulated process which includes accurately, timely and compliantly addressing each of the members concerns. The Operations, Manager will report to the Senior Director of Operations. In this role you will In this role you will provide leadership and support to your team as well as interact with our members and specialty clients. You will also interact directly with our regulator, developing and presenting updates on case activity, discussing trends and observations as well as serving as a primary speaker for regulatory audit activity.

Your Work

In this role, you will:

Responsible for a singular team, department or functional area. Scope of oversight includes planning, cost management and methods
Demonstrate BSC Leadership Behaviors
Foster a great place to work by clearly communicating mission, vision, goals, roles, and expectations for team members; celebrating team achievements; building successful working relationships across the organization
Direct and control the activities of one or more smaller/less complex department(s) or functional area(s) through subordinate supervisors/team leads
Establish operational objectives for department or functional area and participates with other managers to establish group objectives
Ensure team processes are efficient and effective to manage case work timely and accurately
Improve quality results through training and oversight
Establish audit readiness across your team and in partnership with your peers

QUALIFICATIONS
Your Knowledge and Experience

Requires a college degree or equivalent experience and minimum 7 years prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager
Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation
Understands Blue Shield of CA’s mission and business plan
Has functional expertise within the area of responsibility
Requires advanced knowledge of job area usually obtained through advanced education combined with experience
Strong knowledge of the Appeals and Grievances process
Experience interacting with healthcare regulators

Pay Range:

The pay range for this role is: $ 96,500 to $ 144,800 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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ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure 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.

Blue Shield has 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. Here at Blue Shield, 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.

Our Workplace Model:

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.

Two ways of working: Hybrid (our default) and office

Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

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 work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.