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 Work In this role, you will:Be responsible for routine operations, process transformation/efficiency and people management functions Foster 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 PlansUpdate policies and procedures for the Regulatory Team Build and maintaining the relationship with internal departments including the Law Department, Corporate Communications, Claims, Installation and Billing, Provider Services, Network Management, Government Affairs, the Quality Team.Your Knowledge and Experience Requires a high school diploma or GEDRequires 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 requiredKnowledge 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.

Created: 2025-03-06