Provider Disputes Operations Lead

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 120,000 - 160,000; Full time

Job summary

Blue Shield of CA is seeking an experienced Provider Dispute Resolution (PDR) Operations Manager to lead both onshore and offshore teams, ensuring PDR and NSB inventory stay compliant with regulatory guidelines.

You will partner with the PDR Regulatory Audit Manager to drive efficiencies in procedures and systems and to develop strategic initiatives that strengthen the PDR function. This role emphasizes leadership, critical thinking, and cross-functional collaboration.

Qualifications

• Requires a college degree or equivalent experience with at least 7 years in a relevant role.
• Minimum 3 years of management experience as a team lead, supervisor, or project/program manager.
• Experience with scheduling, prioritizing, coaching, process execution, and risk management.
• Prior experience working for a payor in claims or similar business unit.
• Expertise in Commercial, Medi-Cal, and/or Medicare lines of business.
• Auditing or regulatory/compliance experience is preferred.

Responsibilities

• Lead PDR operations to ensure inventory compliance with regulatory guidelines.
• Manage both onshore and offshore teams and drive efficiency.
• Partner with Regulatory Audit Manager to improve procedures and systems.
• Develop and implement strategic initiatives for the PDR department.
• Collaborate with leadership to foster high-performing teams.

Skills

Leadership

Project management

Regulatory compliance

Claims domain knowledge

People management

Strategic thinking

Risk management

Education

College degree

Job description

Blue Shield of CA is seeking an experienced Provider Dispute Resolution (PDR) Operations Manager to lead both onshore and offshore teams, ensuring PDR and NSB inventory stay compliant with regulatory guidelines.

You will partner with the PDR Regulatory Audit Manager to drive efficiencies in procedures and systems and to develop strategic initiatives that strengthen the PDR function. This role emphasizes leadership, critical thinking, and cross-functional collaboration.