Your Role

The Healthcare Business Operations (HBO) team provides centers of excellence for healthcare business resolution practice. Our team is responsible for transforming how we operate throughout the enterprise and has a significant impact on our spend. The Senior Manager, Operations role will report to the Director of Provider Dispute Resolution in Healthcare Business Operations. In this role you will be accountable for planning and executing the business strategy for Provider Dispute Resolution Operations. Additionally, you will be responsible for implementing the training and quality for this team, working cross departmentally with other Centers of Excellence. 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 multiple team(s), department(s) or functional area(s); drives results aligned with planning, cost management and methods
• Foster a great place to work by clearly communicating mission, vision, goals, roles, and expectations for team members; recognizing top talent and team achievements; building successful working relationships across the organization; ensuring a safe and healthy work environment; delivering the tools, time, and talent needed to succeed
• Own the budget management, resource management, process improvements, and technology changes for the team(s), department(s) or functional area(s) within purview of this role
• Develop and implement annual budget
• Manage several related projects, often with the intention of improving the organization's performance
• Develop business actions and outcomes to manage across Provider Dispute Resolution Operations including quality, production, performance analysis, and workforce management practices
• Manage service levels, regulatory, and financial performance of a PDR Operations team across multiple locations
• Ensure that performance objectives and outcomes are consistent with external and internal customer expectations and meet competitive benchmarks; routinely integrates customer feedback and competitive information into ongoing planning and operational activities
• Foster a great place to work by clearly sharing mission, vision, goals, roles, and expectations for team members; recognizing top talent and team achievements; building successful working relationships across the organization; ensuring a safe and healthy work environment; delivering the tools, time, and talent needed to succeed.
• Responsible for making moderate to significant improvements in department, by partnering with training and other key stakeholders.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 10 years of prior relevant experience, including 4 years of management experience
• Minimum 2 years of experience working with PDR (Provider Dispute Resolution) requirements, including experience with Medicare and Medi-Cal regulations and claims processing preferred
• Ability to build strong and sustainable relationships and the capability to interact within all levels of the organization
• Ability to work cooperatively and strategically in a team environment with all levels of professional, technical and administrative staff and to integrate resources on a timely and organized basis
• Acumen to handle complex situations and multiple responsibilities simultaneously with the urgency of immediate demands on the operations
• Ability to present information clearly and concisely to various audiences

Pay Range:

The pay range for this role is: $ 120,000 to $ 180,200 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.