Your Role
The Commercial Appeals & Grievances department performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. The Commercial Appeals & Grievances Supervisor will report to the Commercial Appeals & Grievances Senior Manager. In this role, 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:
- 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
- Stay up to date on legislation and regulations to ensure team compliance
- Interpret audit information requests, prepare narratives, conduct preliminary risk assessments, anticipate adverse findings to prepare for internal corrective action plans
- Make decisions on people and operational matters consistent with goals and objectives
- Provide coaching, performance management, skill development, and guidance on team members' Professional Development Plans
- 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 health care 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
- Note: You may be placed in a specialty client, or other unit, such as CalPERs.
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.
