Supervisor, Operations (Provider Disputes)

Blue Shield of California•Rancho Cordova, CA

16h•Hybrid

About The Position

Your Role The Provider Dispute Resolution (PDR) team researches and resolves issues causing provider abrasion and disputes. The Supervisor will report to the PDR Operations 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. Responsibilities Your Work In this role, you will: Be responsible for routine operations and people management functions. Develop tracking/trending reports at prescribed frequencies for the purpose of identifying and communicating root cause of provider dissatisfaction. Recommend and write corrective action plans. 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. Create and manage an Employee Engagement action plan.

Requirements

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
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
Collecting, analyzing and interpreting provider claim and dispute data
Experience in detecting trends, escalations, staff issues with training/production/quality requiring management attention
Knowledge of inventory and workflow management

Nice To Haves

2+ years’ experience with PDR requirements and Commercial knowledge including experience with Commercial claims processing preferred.

Responsibilities

Be responsible for routine operations and people management functions.
Develop tracking/trending reports at prescribed frequencies for the purpose of identifying and communicating root cause of provider dissatisfaction.
Recommend and write corrective action plans.
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.
Create and manage an Employee Engagement action plan.