The Appeals and Grievances team is responsible for resolving our members concerns through a regulated process which includes accurately, timely and compliantly addressing each of the members concerns. The Senior Manager of Operations will report to the Senior Director of Operations. In this role you will provide leadership and support to your team as well as interact with our members and specialty clients.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,buildingand sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
- Be responsible for multiple team(s), department(s) or functional area(s); drives results aligned with planning, cost management and methods
- Foster a great place to work by clearly communicating mission, vision, goals, roles, and expectations for team members; recognizing top talent and team achievements; building successful working relationships across the organization; ensuring a safe and healthy work environment; delivering the tools, time, and talent needed to succeed
- Own the budget management, resource management, process improvements, and technology changes for the team(s), department(s) or functional area(s) within purview of this role
- Develop and implement annual budget
- Manage several related projects, often with the intention of improving the organization's performance
- Manage internal and regulatory audit activity
- Drive quality improvement and efficiency in processes
- Monitor case activity ensuring timeliness and accuracy of all work
- Trend top drivers of appeals and grievances, working with upstream and downstream partners to reduce member pain points
- Responsible for making moderate to significant improvements in department, by partnering with training and other key stakeholders.
Your Knowledge and Experience
- Requires a bachelor’s degree or equivalent experience
- Requires at least 10 years of prior relevant experience, including 4 years of management experience
- Direct experience with Appeals and Grievances is required
- Regulatory audit experience preferred
- Ability to build strong and sustainable relationships and the capability to interact within all levels of the organization
- Acumen to handle complex situations and multiple responsibilities simultaneously with the urgency of immediate demands on the operations
- Ability to present information clearly and concisely to various audiences
- Note: You may be placed in a specialty client, or other unit, such as CalPERs.