Operations Specialist, Experienced

Blue Shield of California • Woodland Hills, CA

5d

About The Position

Your Role The Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC) which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities. This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities. Reporting to the Manager, Delegation Oversight, this role is responsible for documentation of policies and procedures, and oversight of LA Care audits and quality review along with submission of data to compliance. The Operations Specialist, Experienced, is also responsible for working with colleagues on coordination and submission of state reporting to the Department of Managed Health Care (DMHC) . This position is responsible for tracking and monitoring monthly, quarterly, and annual reporting timeliness and Provider Dispute Resolution to provide into the DMHC portal reporting. The Operations Specialist, Experienced position also reviews and provides to the DMHC Corrective Action Plans (CAPs) and requests for information.

Requirements

• Requires a college degree or equivalent experience
• Requires 3 years of prior relevant experience
• Strong verbal and written communication skills
• Strong knowledge of Microsoft Office products
• Strong organizational and attention to detail skills

Nice To Haves

• Experience working in or with IPA/Medical Groups is preferred

Responsibilities

• Act as a subject matter expert (SME) to review operational workflows of high degree of complexity and/or for multiple departments, identifying problems and developing improvements, modifications, and enhancements
• Develop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff
• Develop and generate reports ranging from routine to moderately complex for management review
• Track and communicate workflow and system changes to appropriate resources
• Participate as a SME in the development of written guidelines and documents problems
• Assist with documentation needs
• Maintain and update trackers required for business operations
• Perform other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees