Provider Disputes Operations Leader - Hybrid

Blue Shield of CA; Long Beach (CA); Hybrid; USD 120,000 - 150,000; Full time

Job summary

Blue Shield of CA is seeking an PDR Operations Manager to lead the Provider Dispute Resolution efforts across multiple lines of business and to partner with an offshore vendor. The role focuses on keeping PDR and NSB activities compliant while driving efficiencies through process improvements and strategic initiatives.

The role emphasizes leadership development, critical thinking, and building high-performing teams with opportunities for growth and learning.

Qualifications

• 7+ years of relevant experience, including 3 years in a management role.
• Experience with work scheduling, prioritizing, coaching and process execution.
• Understanding of Blue Shield of CA's mission and business plan.
• Experience in payor claims or similar business unit.
• Experience with at least one of Commercial, Medi-Cal and/or Medicare.

Responsibilities

• Oversee onshore and offshore provider dispute resolution teams.
• Ensure PDR and NSB inventory complies with regulatory guidelines.
• Collaborate with PDR Regulatory Audit Manager to improve procedures and systems.
• Develop and implement strategic initiatives to enhance the PDR department.
• Report to the Director of PDR and lead cross-functional collaboration.

Skills

Team leadership

Project management

Coaching

Work scheduling

Risk management

Education

College degree or equivalent experience

Job description

Blue Shield of CA is seeking an PDR Operations Manager to lead the Provider Dispute Resolution efforts across multiple lines of business and to partner with an offshore vendor. The role focuses on keeping PDR and NSB activities compliant while driving efficiencies through process improvements and strategic initiatives.

The role emphasizes leadership development, critical thinking, and building high-performing teams with opportunities for growth and learning.