Supervisor, Operations

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 truly 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 comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Your Role

The provider dispute resolution 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
• 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
• Complete a minimum of 2 audits per employee, per month with a focus on claims processing and interest accuracy: in alignment with all PDR process documentation
• Create and manage great place to work action plan

Your Knowledge and Experience

• Requires a minimum of 5 years of prior relevant experience, with a minimum of 2 years experience operating in a lead role or equivalent leadership training or manager training
• Requires 2+ years experience with PDR requirements, including experience with Medi-Cal claims processing.
• Requires 5+ years of hands-on experience with Medi-Cal line of business
• 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
• Recommends and writes corrective action plans
• Collects, analyzes and interprets provider claim and dispute data
• Develops tracking/trending reports at prescribed frequencies for the purpose of identifying and communicating root cause of provider dissatisfaction
• Experience in detecting trends, escalations, staff issues with training/production/quality requiring management attention
• Knowledge of inventory and workflow management

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