Your Role
The Medicare Appeals and Grievances team is responsible for compliance processing of Medicare appeals and grievances. The supervisor will report to the Manager for Medicare Appeals and Grievances. In this role you will manage the daily, short-term, and/or long-term activities of the customer service and operations teams to ensure alignment with service levels and providing service worthy of our family and friends. You will be responsible for the oversight of quality, production levels, strategic initiatives, employee development, preparation and management of budgets, goals, objectives, and results for various operational areas. 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
- Contribute towards achieving the organizations Medicare Stars goals
Your Knowledge and Experience
- Requires a 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
- Knowledge of Medicare preferred.
- Experience working with appeals and grievances in healthcare preferred
- Ability to work collaboratively across diverse teams to improve processes and policies with a focus on the customer experience.
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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