Your Role

The Quality Assurance team provides audits to the Appeals and Grievances Department for the Commercial, Medicare and Medi-Cal lines of business to ensure high levels of quality and regulatory compliance. The Supervisor will report to the Sr. Manager for Appeals and Grievances. In this role you will supervise a team of Quality Assurance Auditors and be responsible for people and process management. 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 routine operations and people management functions
• Foster a great place to work communicating clear roles and responsibilities and building successful working relationships across the organization
• Consult and make recommendations to management on operational issues
• Use concepts and abilities to manage processes and operations, including procedural changes, inventories, and workload management
• Apply policies and procedures within health care operations
• Stay up to date on legislation and regulations to ensure team compliance
• Make decisions on people and operational matters consistent with goals and objectives
• Instructs, guides, and oversees work of non-exempt staff with general direction from manager
• Provide coaching, performance management, skill development, and guidance on team members' Professional Development Plans
• Ensure that the Quality Program is capturing all regulatory requirements
• Contribute towards achieving the organizations Medicare Stars goals

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
• Knowledge of Quality Assurance practices and auditing experience preferred
• Knowledge of Commercial, Medicare and Medi-Cal regulations preferred
• Experience working with appeals and grievances in healthcare preferred
• Ability to work collaboratively across diverse teams to improve processes and policies with a focus on customer experience.

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.