Manager, Operations

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Description

Your Role 


The Provider Dispute Resolution (PDR) Operations team manages and processes provider disputes across the Commercial, Medi-Cal and Medicare lines of business and the No Surprise Billing(NSB) process. The team also partners with an offshore vendor to complete provider disputes and other strategic projects. The PDR Operations Manager will report to the Director of PDR. In this role you will be responsible for ensuring PDR and NSB inventory stays within compliance and regulatory guidelines, manage both onshore and offshore teams, and partner with the PDR Regulatory Audit Manager to create efficiencies in procedures, systems, and develop and implement strategic initiatives that will enhance the PDR department.  

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.
 



Responsibilities

Your Work 
In this role, you will: 

  • Be responsible for the PDR Operations team over the Commercial, Medi-Cal and Medicare lines of business and the No Surprise Billing Team. Scope of oversight includes planning, cost management, regulatory compliance and strategy, audit preparation and planning, and creating strategic initiatives to drive production  
  • Demonstrate BSC Leadership Behaviors  
  • Foster a great place to work by clearly communicating mission, vision, goals, roles, and expectations for team members; celebrating team achievements; building successful working relationships across the organization 
  • Direct and control the activities of one or more smaller/less complex department(s) or functional area(s) through subordinate supervisors/team leads 
  • Establish operational objectives for department or functional area and participate with other managers to establish group objectives 
  • Manage the No Surprise Billing Team and ensure admin fees and cases are completed timely and within compliance standards of the No Surprises Act mandate 
  • Ensure team processes are efficient and effective to manage case work timely and accurately
  • Partner with PDR Regulatory Audit Manager in developing new procedures and guidelines for onshore and offshore PDR teams that are aligned with regulatory requirements and improve quality results through training and oversight 
  • Establish audit readiness across the team and in partnership with your peers and represent the department during all audit activity 
  • Present in Operational Committees, trend top drivers of provider disputes, and work with upstream and downstream partners to reduce provider pain points

 



Qualifications

Your Knowledge and Experience 

  • Requires a college degree or equivalent experience and minimum 7 years prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager 
  • Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation  
  • Understands Blue Shield of CA’s mission and business plan 
  • Has functional expertise within the area of responsibility 
  • Requires advanced knowledge of job area usually obtained through advanced education combined with experience 
  • Requires previous experience working for a payor in claims or similar business unit 
  • Requires expertise in at least one or more of the following lines of business – Commercial, Medi-Cal and/or Medicare 
  • Prior auditing and/or compliance/regulatory experience is preferred 
  • Possess the acumen to handle complex situations and responsibilities simultaneously with the urgency of immediate demands brought by leadership or other departments 

 

Hybrid


This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

 



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Top 25 Common Interview Questions and Answers

To get a job means you must be ready for an interview. Most people get confused about how they should face an interview to impress the employer. The fact cannot be ignored that landing an interview is no less than a huge achievement as we know how competitive today’s world is. Clearing an interview means you would be securing the job. It does not matter if you are a fresh graduate, are supposed to transition your career, or believe to have a higher position, preparing for an interview is important indeed.

Here, we are going to share the top 25 highly common interview questions along with tips as well as sample answers to help you stand out from others in today’s highly competitive job market in the USA.

1. Give me your introduction in short.

This is the most common questions asked by every interviewer. The fact cannot be ignored that it irritates sometimes as well. But the fact cannot be ignored that it is important as well to fetch important information about an employee.
“Myself ....(your name)…. and I hold a degree in ……….(your field name)……… from…..(university name)... .over….(duration of your). I hold experience in ….(respective field)... .specialized in ….(share your genre)... .Currently, I am working on a project and received positive reviews from the employer.

2. Describe your excellent achievement in your job career.

My greatest achievement was leading a team to do a prominent project within a stipulated time and budget. And that project set our company different from its competitors among our clients.

3. What are the reasons to work with us?

Upon asking this question, you should emphasize that you are aware of the company’s profile and adhere to align your values with theirs. I have always admired this company because of its sustainability and innovation factors. I will keep working with you and contribute to taking it to the next level.

4. Reasons to quit your last job.

The reason to quit my last job is to seek more new challenges and opportunities for growth. I want to hone my skills in a new environment. I believe in keeping going on with new challenges as I think that comfort zone eradicates your creativity.

5. What about your strengths?

Here, you need to be smart and relevant both at the same time. Problem Solving is one of my key strengths. I believe in focusing on the solution and can improve your efficiency by 20% by introducing strategic solutions.

6. What is your weakness?

I believe in doing every work with so much perfection and it takes me slow sometimes. However, I am trying to balance quality and efficiency by dividing my attention towards goals and deadlines.

7. Why should we hire you?

With my huge experience in …………. And holding a proven track record of delivering projects within time, I believe in my ability to cater to your team effectively. Moreover, I believe in giving the best to my work as it brings personal satisfaction to me.

8. In your previous company, what prominent challenges did you face, and how did you deal with them?

In my previous company job profile, we faced a sudden budget cut and delivered a project within the stipulated time with no huge team. I led my team and accomplished that project within that limited budget and time without compromising project quality. Accomplishing a project within a limited budget always makes me feel proud.

9. What is your ideal way to tackle stress and pressure?

I believe in being organized and prioritizing tasks. Once you know how much time you need to give to a particular task, it helps to cut down on high pressure. I believe in making a strategy to get the most out of it. I believe in being calm under pressure.

10. What is your way to prioritize your work?

I believe in going with the deadlines and significance of the project to keep myself productive and free from stress. Moreover, I keep working on a progress tracker to keep boosting my energy.

11. Things that motivate you.

Solving complex issues is what keeps me motivated and seeing the tangible results of my work. Moreover, dynamic as well as innovative environments always boost me up.

12. What is your way of handling criticism?

I always see criticism as a way to hone my skills and an opportunity to learn and grow. I always listen quite carefully and act accordingly to come up with satisfactory results.

13. Describe a time you worked in a team.

I collaborated with a diverse team in my last company to come up with a new marketing strategy. My role in that team was to integrate social media efforts resulting in 25% increased engagement.

14. What is your way of dealing with difficult coworkers?

I am a firm believer in addressing conflicts directly and professionally to come up with a solution. Open communication is my asset and understanding different perspectives to solve issues amicably.

15. Reasons to get this job?

This job sits well with my skills in this field as well as my passion for learning more about new things. I am excited to contribute and learn more in your company professionally.

16. How would you be handling multiple deadlines if given?

The simple thing from my perspective is to stay organized and divide the tasks into manageable steps. I believe in doing the work based on urgency and impact.

17. Tell us about the time you failed badly in your job.

Once I missed a significant deadline because of not being good at time management. This is how I learned about time management and being adhered to realistic goals to improve my planning skills in an ideal manner.

18. How do you see yourself outside of work?

I enjoy reading a lot related to my profession. Moreover, reading makes me calm too. Apart from that, hiking and roaming to peaceful places are my favorite things to do.

19. What are your salary expectations?

Following my research and the responsibilities of the role, I expect a salary in the range of $...... to $..... Though, I am open to knowing your side as well.

20. What do you expect from yourself in the next five years?

I am a keen learner and want to expand my knowledge by getting associated with your company. I want to take on more leadership responsibilities and contribute to achieving success in highly creative ways.

21. What do you think about the latest industry trends and changes?

I believe in keeping myself updated about the latest and ongoing industry trends and changes. I keep following the latest job profile e-newsletter; and also attend relevant webinars and conferences. Learning is a never-ending process.

22. How do you describe your ideal work environment?

For me an ideal work environment is all about having open communication and teamwork to achieve success, to learn more, and to have excellent professional growth.

23. How aware are you of our company?

I know this company has established itself as one of the prominent companies in today’s tech industry. It is known for its excellent solutions, creative ways, and commitment to sustainability. The current services and their success rate make this company completely different from others.

24. What skills can you add to this job?

I have been in this field for the past 5-6 years and hold huge experience identifying trends that lead to exceptional business growth. I am also good at communication and teamwork to make the most of it.

25. Do you have any questions for us?

Yes, I would like to know more about the team I would be working with. What sort of challenges are the team currently going through? What is about the career growth in this company?