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 functionsFoster a great place to work communicating clear roles and responsibilities and building successful working relationships across the organizationConsult and make recommendations to management on operational issuesUse concepts and abilities to manage processes and operations, including procedural changes, inventories, and workload managementApply policies and procedures within health care operationsStay up to date on legislation and regulations to ensure team complianceInterpret audit information requests, prepare narratives, conduct preliminary risk assessments, anticipate adverse findings to prepare for internal corrective action plansMake decisions on people and operational matters consistent with goals and objectivesProvide coaching, performance management, skill development, and guidance on team members’ Professional Development PlansPerform other related duties as assignedYour Knowledge and Experience
Requires High School Diploma or GEDRequires a minimum of 5 years of prior relevant experienceRequires a minimum of 2 years of experience operating in a lead role or equivalent leadership training or manager trainingRequires 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 executionRequires broad knowledge of technical or operational practices within assigned disciplineCommercial experience preferredMust 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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