The CalPERS team processes and responds to appeals, grievances, and inquiries from members, regulatory agencies, and CalPERS directly
Job Summary
The CalPERS team processes and responds to appeals, grievances, and inquiries from members, regulatory agencies, and CalPERS directly.
This role involves comprehensive research, managing time to meet compliance metrics, and preparing detailed responses for regulatory agencies.
Blue Shield of California is committed to creating a healthcare system that is sustainably affordable and enhances the member and physician experience.
Matching Summary
The CalPERS team processes and responds to appeals, grievances, and inquiries from members, regulatory agencies, and CalPERS directly.
Skills & Requirements
Must-have
Comprehensive research of member complaints
Manage time to meet compliance metrics
Prepare detailed file summary responses
Respond to complex regulatory inquiries
Research data files and gather information
Communicate with leadership and agencies
Nice-to-have
Energized by creative and critical thinking
Building and sustaining high-performing teams
Fostering continuous learning
Positive change across industry
Key Requirements
High school diploma or GED
At least 3 years of experience
At least 2 years in health insurance operations
At least 1 year direct appeals/grievance experience
Experience with Commercial lines of business preferred