Supervisor, Operations

JOB DESCRIPTION
Your Role

The Provider Dispute Resolution (PDR) team researches and resolves issues causing provider abrasion and disputes. The Supervisor will report to the Senior Manager. In this role you will manage a team of coordinators, focusing on coaching/engagement, inventory management, auditing the team, and providing valuable insight into areas of opportunity to improve the process. 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:

• Be responsible for routine operations and people management functions.
• Develop tracking/trending reports at prescribed frequencies for the purpose of identifying and communicating root cause of provider dissatisfaction
• Recommend and write corrective action plans.
• Foster a great place to work, communicating clear roles and responsibilities, and building successful working relationships across the organization.
• Consult and make recommendations to management on operational issues.
• Use concepts and abilities to manage processes and operations, including procedural changes, inventories, and workload management.
• Apply policies and procedures within health care operations.
• Provide regular coaching to each team member, including audit feedback, corrective actions, performance improvement, skill development, and PDP creation/enhancement.
• Manage onboarding of new team members as well as all needed security requests for the team you lead.
• Create and manage an Employee Engagement action plan.

QUALIFICATIONS
Your Knowledge and Experience

• 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 2+ years’ experience with PDR requirements and Medicare knowledge including experience with Medicare claims processing.
• Ability to analyze data, summarize and present findings – apply critical thinking skills
• Capability/experience with writing letters in response to provider disputes and P&Ps
• Collecting, analyzing and interpreting provider claim and dispute data
• Experience in detecting trends, escalations, staff issues with training/production/quality requiring management attention
Knowledge of inventory and workflow management

Pay Range:

The pay range for this role is: $ 66,600 to $ 98,900 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.

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.