Supervisor, Operations (Regulatory Appeals)

Your Role

The Regulatory Appeals and Grievances team is responsible for compliant processing of appeals and grievances. The Operations, Supervisor will report to the Manager for Appeals and Grievances. In this role you will be responsible for supporting and maintaining the relationships between Blue Shield, and regulators including the Department of Managed Healthcare, Department of Insurance, and the Office of Personnel Management. You will be also 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. 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.

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
• Experience working with appeals and grievances in healthcare required
• Knowledge and experience working with state regulatory agencies in healthcare preferred
• Experience reading regulation, senate bills, and all plan letters (APL) preferred
• Appeals and grievances regulatory audit experience preferred
• Ability to work collaboratively across diverse teams to improve processes and policies with a focus on the customer experience.