Manager, Operations

o About Blue Shield of California: For more than 80 years, Blue Shield has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 7,500 employees, more than $21 billion in annual revenue and 4.5 million members. The company has contributed more than $500 million to the Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield is headquartered in Oakland, California with 21 additional locations including Sacramento, Los Angeles, and San Diego.
o Our Benefits: At Blue Shield you can expect a comprehensive benefits program that offers choice and flexibility for our diverse workforce. These programs and resources include: Medical, Dental, and Vision plan benefits, 401(k) with employer match, paid time off (PTO), earned sabbatical time, paid nonprofit volunteer time, flexible work program, free online education, tuition reimbursement, a wellness reimbursement program, 12 weeks paid parental leave, and more.

Description

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!

Your Role

The Claims Operations team is responsible to manage the day-to-day operations of the department. The Claims Operations Manager will report to the Director of Claims Operations. In this role you will manage claims staff and be responsible to perform oversight of the offsite vendor. 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.

Your Work

In this role, you will:
  • Be responsible for a singular team, department, or functional area; scope of oversight includes planning, cost management and methods
  • Direct and control the activities of one or more smaller/less complex department(s) or functional area(s) through subordinate supervisors/team leads
  • Provide developmental and training opportunities for team members
  • Establish operational objectives for department or functional area and participate with other managers to establish group objectives
  • Manage and/or oversee intra and inter departmental projects
  • Ensure department is meeting regulatory requirements for all lines of business as it relates to the work volume and the quality
  • Establish performance metrics and manage team to ensure they meet their metrics.
  • Mentor/counsel and provide guidance/support to team
  • Collaborate with internal Stakeholders that impact the department
  • Ensure all tools utilized by team are up to date and meets regulatory guidelines (i.e, Claims P&P, Claims DLP)




Qualifications

Your Knowledge and Experience

  • Requires a bachelor's degree or equivalent experience
  • Requires at least 7 years of prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager
  • Must to be results-oriented and can prioritize and manage competing priorities
  • Requires knowledge of CMS, DHCS, DMHC guidelines/regulations
  • Medi-Cal experience is highly preferred
  • Should have a strong background in data analysis, problem solving, and managing resources
  • Should have the ability to engage and inspire; foster open communication; establish plans; manage and improve processes; build relationships


Our Values

  • Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short
  • Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes
  • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals




Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.


External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
COVID-19 update: From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a federal contractor and a health care company, Blue Shield requires all employees to be fully vaccinated prior to start date as a condition of employment and provide proof of vaccination status. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date
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