Litigation Specialist, Senior

Your Role

The Law Department’s Dispute Resolution team responds to threatened and pending health care disputes, with a particular focus on litigation, provider arbitrations, regulatory enforcement actions and subpoenas. The Sr. Litigation Specialist will report to the supervising Managing Associate General Counsel. In this role you will be responsible for gathering facts and information, conducting detailed review of disputed claims in arbitration, organizing and producing documents and data needed to defend Blue Shield of California (“BSC”) in disputes and testifying in evidentiary hearings regarding claims processing issues.

Your role will also involve administrative responsibilities such as calendaring, meeting scheduling, preparation of reports, and document filing in support of the supervising Managing Associate General Counsel. Occasional travel will be required. The successful candidate will have excellent analytical and organizational skills, the ability to work independently and diligently manage tasks and projects under deadlines with minimal supervision. The successful candidate will be part of a close working team. All Zoom/Teams meetings take place with cameras on to increase connectivity among team members. Working well in a team is an essential part of this role.

Your Work

In this role, you will

• Assist attorneys in the Dispute Resolution Group of the Law Department, and outside attorneys representing BSC, in gathering facts and information needed to respond to threatened and pending litigation or arbitration brought by members and providers of service
• Conduct in-depth reviews of disputed claims from all lines of business to help BSC attorneys evaluate Company liability
• Assist BSC attorneys in responding to regulatory agencies on regulatory compliance investigations and inquiries
• Be responsible for finding, gathering, organizing, summarizing, producing and analyzing documents and information in BSC’s systems and held by BSC employees
• Identify witnesses and testify when needed regarding work done to gather evidence and other information; testify in arbitrations (virtually and in person) regarding claims processing issues and interact with BSC employees across the company to investigate facts and gather documents
• Regularly interact with BSC’s outside legal counsel regarding time- sensitive information and document requests
• Conduct analysis of legal claims, and prepare up-to-date and accurate reports, memoranda, and spreadsheets regarding findings
• Carry out analytical and process management tasks with a high degree of autonomy, and work collaboratively with BSC attorneys, and other paralegals and litigation specialists
• Validate and coordinate responses to subpoenas, and ensure accurate, timely gathering and production of requested documents

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Provide administrative support for the supervising Managing Associate General Counsel, such as calendaring, meeting scheduling, making travel arrangements, preparation of reports, and document filing

Your Knowledge and Experience

• Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• Requires at least 5 years of recent experience processing, adjudicating and/or auditing facility and/or professional claims on behalf of a healthcare payor
• Requires strong analytical and problem-solving skills, strong organizational and file management skills, the ability to effectively prioritize competing demands and shift focus between multiple tasks,
• Requires the ability to communicate effectively with stakeholders across BSC, as well as with outside individuals/entities and to represent BSC as a witness at hearings, arbitrations, and trials
• Requires significant experience and expert proficiency with retrieving data from claims processing systems and analyzing claims to determine whether they were adjudicated correctly
• Requires experience and proficiency working in Word, Excel, PowerPoint, Outlook, Teams and Adobe
• Requires extensive experience and expert proficiency retrieving data from the following Blue Shield of California systems, including FACETS, BSC Enterprise Report Management System, Business Objects, Division of Financial Responsibility Matrix, Contraxx Contracting Portal, Enterprise Vault – Thunderhead, AuthAccel – MedHok and Document DNA, Documentum and IBM Content Navigator
• Experience working on the Hospital Exception And Transplant (“HEAT”) team is highly desired

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.