What are the responsibilities and job description for the Operations Specialist, Experienced position at Blue Shield of California?
Your Role
The Pharmacy Claims Quality team provides oversight to ensure Pharmacy claims process accurately. The Operations Specialist, Experienced will report to the Pharmacy Claims Quality Manager. In this role you will ensure claims processing accuracy by reviewing claims daily for multiple lines of business.
Your Work
In this role, you will :
- Act as subject matter expert and reviews operational workflows, identifying problems and develops improvements, modifications, and enhancements
- Maintain databases required for business operations
- Develop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff
- Develop and generate reports for management review; notify appropriate department mangers about issues and problems in operational workflow requiring immediate attention
- Participate as a subject matter expert in the development of written guidelines and documents problems as needed
- Review claims reporting daily
- Own the Quarterly / Annual CalPERS claims accuracy reporting
- Own the monthly Medicare recoupment process
- Quarterly Web Testing
Your Knowledge and Experience
