Summary
Overview
Work History
Skills
References
Timeline
Generic

Julie Bair

Saratoga Springs

Summary

Healthcare professional with 25 years of experience at Blue Shield of California, specializing in customer service, claims processing, and provider contracts. Demonstrated ability to enhance operational efficiency through cross-functional collaboration and complex issue resolution. Successfully trained offshore teams in provider appeals, resulting in improved compliance and performance. Strong leadership skills drive commitment to operational excellence.

Overview

25
25
years of professional experience

Work History

Lead for Provider Dispute Resolution Team

Blue Shield of California
Rancho Cordova
01.2023 - 05.2025
  • Managed multiple email boxes
  • Managed daily inventory to ensure cases were closed in compliance.
  • Coordinated with other departments, SIU, audits, and Facility Compliance Review to ensure cases would be closed within compliance.
  • Trained all aspects of the Blue Shield appeals processes and provided continuous support to the offshore management team.
  • Provided feedback on appeal cases handled incorrectly.
  • Developed instructional guides for appeal processes.
  • Aided management on the No Surprise Act (Federal IDR Process).
  • Back up supervisor for inventory management meetings.
  • Aided coordinators with processes and closing cases.
  • Investigated complex cases for management, law offices, and analysts to determine the correct resolution.
  • Demonstrated ability to proactively identify problems, as well as recommend solutions.

Provider Dispute Resolution Coordinator

Blue Shield of California
07.2005 - 01.2023
  • Process all types of provider appeals within prescribed regulatory timeframes
  • Handle expedited cases for management and request escalation when needed
  • Assist with lead email box when needed
  • Manage other coordinators cases when they are out of the office
  • Provide recommendations for updates to desk level procedures
  • Provide assistance to other coordinators on complex cases
  • Provide training and assistance to new coordinators on the appeals process
  • Participated in sprints to make improvements to appeals processes
  • Interim Lead from September 2006 to December 2006

Correspondence Representative

Blue Shield of California
07.2003 - 07.2005
  • Provided written responses to member and provider inquiries within required timeframes
  • Assisted supervisor with inventory management
  • Responsible for assisting coordinators with member and provider cases with greater complexity
  • Responded to email inquiries from members (E-Service)

Customer Service Representative

Blue Shield of California
08.2000 - 06.2003
  • Responded to phone calls from members and providers
  • Provided benefit information to members and providers for HMO and PPO lines of business
  • Researched and resolved claim issues for members and providers
  • Assisted members in resolving issues they encountered at the pharmacy or with IPA/Medical Groups
  • Managed inventory and consistently assisted with inventory reduction

Skills

  • Provider dispute resolution
  • Process improvement
  • Regulatory compliance
  • Escalation management
  • Appeals training
  • Case management
  • Training

References

References available upon request.

Timeline

Lead for Provider Dispute Resolution Team

Blue Shield of California
01.2023 - 05.2025

Provider Dispute Resolution Coordinator

Blue Shield of California
07.2005 - 01.2023

Correspondence Representative

Blue Shield of California
07.2003 - 07.2005

Customer Service Representative

Blue Shield of California
08.2000 - 06.2003

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Julie Bair