Supervisor, Operations; Provider Disputes

Supervisor, Operations (Provider Disputes)

and 7 more

Your Role

The Provider Dispute Resolution (PDR) team researches and resolves issues causing provider abrasion and disputes. The Supervisor will report to the PDR Operations Manager. In this role you will manage a team of coordinators, focusing on coaching/engagement, inventory management, auditing the team, and providing valuable insight into areas of opportunity to improve the process.

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.
• Develop tracking/trending reports at prescribed frequencies for the purpose of identifying and communicating root cause of provider dissatisfaction.
• Recommend and write corrective action plans.
• 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.
• Provide regular coaching to each team member, including audit feedback, corrective actions, performance improvement, skill development, and PDP creation/enhancement.
• Manage onboarding of new team members as well as all needed security requests for the team you lead.
• Create and manage an Employee Engagement action plan.

Your Knowledge and Experience

• 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
• 2+ years’ experience with PDR requirements and Commercial knowledge including experience with Commercial claims processing preferred.
• Ability to analyze data, summarize and present findings – apply critical thinking skills
• Capability/experience with writing letters in response to provider disputes and P&Ps
• Collecting, analyzing and interpreting provider claim and dispute data
• Experience in detecting trends, escalations, staff issues with training/production/quality requiring management attention
• Knowledge of inventory and workflow management

Hybrid Virtual Work

This role allows employees to work virtually full‑time, however employees will be expected to come to the office based on business need.

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan;
Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield isa U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair
360 as a Top Regional Company, and one of the 50 most community‑minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a…