Hybrid Operations Manager - Provider Disputes & NSB

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 140,000 - 180,000; Full time

Job summary

Blue Shield of California is seeking an experienced PDR Operations Manager to oversee provider disputes across Commercial, Medi-Cal and Medicare, coordinating onshore and offshore teams and ensuring tasks stay compliant with regulatory requirements.

You will partner with the PDR Regulatory Audit Manager to drive process improvements, lead with a growth mindset, and implement strategic initiatives that strengthen the PDR function and advance organizational goals.

Qualifications

• Requires college degree or equivalent experience and minimum 7 years prior relevant experience, including 3 years management experience
• Understands work scheduling, prioritizing, coaching and process execution
• Experience in a payor claims or similar business unit preferred

Responsibilities

• Oversee PDR/NSB operations across Commercial, Medi-Cal and Medicare lines
• Manage onshore and offshore teams and ensure inventory stays within regulatory guidelines
• Partner with the PDR Regulatory Audit Manager to improve procedures, systems and implement strategic initiatives

Skills

Leadership

Project management

Regulatory/compliance

Risk management

Education

Bachelor's degree

Job description

Blue Shield of California is seeking an experienced PDR Operations Manager to oversee provider disputes across Commercial, Medi-Cal and Medicare, coordinating onshore and offshore teams and ensuring tasks stay compliant with regulatory requirements.

You will partner with the PDR Regulatory Audit Manager to drive process improvements, lead with a growth mindset, and implement strategic initiatives that strengthen the PDR function and advance organizational goals.