What are the responsibilities and job description for the Supervisor, Operations (Commercial Appeals and Grievances) position at Blue Shield of California?
Your Role
The Commercial Appeals & Grievances department performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. The department partners with the customer service and operations teams to ensure alignment with service levels to provide service worthy of our family and friends. 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 in a manner that is consistent with regulatory requirements and department policies and procedures. You will manage projects and participate in regulatory audit activities. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially.
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 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.
- 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 experience preferred Must be willing to work weekends and holidays as needed
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.
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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:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:
Member-facing and approved out-of-state roles remain remote.
Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. 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.
Salary : $66,600 - $98,900
