JOB DESCRIPTION
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
• Developing strategies to ensure provider payments are accurate and appropriate
• Establish processes to help ensure payments are accurately paid in accordance with contracts and industry standards
• Develop and execute audit procedures to verify system of internal controls for payment accuracy
• Develop applicable policies and procedures for the Claims Payment Integrity team
• Communicate routinely with internal key-stakeholders on progress and forecasts
• Manage and build relationships with external vendors that assist in payment integrity activities
• Provide recommendations on design and solutions for payment quality improvements
• Act as a liaison between Finance, Claims, Vendors, Clinical Quality, and leadership to build holistic solutions that drive results
• Team leadership skills to drive both engagement and results
  

Pay Range:

The pay range for this role is: $ 94160.00 to $ 141240.00 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.

• QUALIFICATIONS
  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
• Requires an ability to be good with numbers as the role deals with financial figures, math, and reporting
• Requires an ability to present data for senior leader consumption to articulate progress, results, and predictions

ABOUT THE TEAM
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!

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.

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 health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.