Operations Manager: Provider Disputes & NSB

Blue Shield of CA; San Diego (CA); Hybrid; USD 150,000 - 190,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of California seeks an PDR Operations Manager to lead the Provider Dispute Resolution team, overseeing disputes across Commercial, Medi-Cal and Medicare, and directing the No Surprise Billing process. The role reports to the Director of PDR and focuses on compliance, efficiency, and strategic program execution.

The candidate will oversee both onshore and offshore teams, partner with regulatory audits, and drive improvements that support the PDR department's mission and business goals.

Qualifications

• College degree or equivalent experience; minimum 7 years in a relevant role.
• At least 3 years of management experience (team leader, supervisor or project/program manager).
• Experience with work scheduling, prioritization, coaching, and process execution.
• Experience working for a payor in claims or related business unit.
• Expertise in Commercial, Medi-Cal and/or Medicare lines of business.

Responsibilities

• Ensure PDR and NSB inventory stays compliant with regulatory guidelines.
• Manage both onshore and offshore teams and coordinate with stakeholders.
• Partner with the PDR Regulatory Audit Manager to improve procedures, systems and efficiencies.
• Develop and implement strategic initiatives to enhance the PDR department.

Skills

Team leadership

Coaching

Process execution

Risk management

Strategic thinking

Education

College degree or equivalent

Job description

Blue Shield of California seeks an PDR Operations Manager to lead the Provider Dispute Resolution team, overseeing disputes across Commercial, Medi-Cal and Medicare, and directing the No Surprise Billing process. The role reports to the Director of PDR and focuses on compliance, efficiency, and strategic program execution.

The candidate will oversee both onshore and offshore teams, partner with regulatory audits, and drive improvements that support the PDR department's mission and business goals.