Associate General Counsel, Sr Principal - Appeals and Grievances Greater San Francisco, CA Area

Your Role

The Medical Care Solutions team is responsible for various client support within Blue Shield of California, including the Appeals and Grievances Department and Customer Service Team, Behavioral Health, Medical Policy, Utilization Management, Pharmacy and Regulatory Filings. The Associate General Counsel, Sr. Principal, will report to the Managing Senior Director. In this role you will support the Appeals and Grievances Department in its interactions with state regulators, specifically by assisting with cases related to member appeals of health plan denials and provide legal support for operational and policy projects related to customer service outcomes from member appeals.

RESPONSIBILITIES

Your Work

In this role, you will:

• Coordinate with and support the Appeals and Grievances Department (AGD) to analyze and respond to complex member appeals from the Department of Managed Health Care Help Center.

• Conduct legal research and guide staff research into member cases and assist with outreach to internal departments to support the AGD Regulatory and Clinical teams.

• Conduct legal research and analysis on applicable laws and regulations, including those raised by the regulator through requests for information (RFIs) and requests for health plan information (RHPIs).

• Support development of policies and procedures to identify gaps and adjust for trends and lessons learned from complaints and appeals cases, for AGD, Utilization Management and Customer Service teams.

• Meet with state regulators and serve as lead as necessary to discuss appeals cases, policies and procedures, and ongoing administrative/legal issues.

• Participate in discussions with internal leadership and external regulator leadership regarding escalated disagreements related to statutory interpretation and process.

• Provide support to more senior attorneys, as needed.

• Coordinate with other Law Department subject matter experts, including the Litigation team, and liaise with outside counsel as needed.

• Assist in the development and implementation of legal strategies to protect the company's interests and manage risks.

• Coordinate with other departments internally to gather information for assigned tasks.

• Influence others regarding policies, practices, and procedures.

• Become proficient in assigned area/specialty and develop proficiency in one additional area/specialty in department

• Create, foster, and maintain relationships with internal clients and external stakeholders and constituents that enhance the Company’s reputation as a health plan, employer, and corporate citizen.

• Work independently, under the guidance of more senior attorneys who will sometimes review recommendations and decisions and communicate effectively with managing senior director.

• Other duties as assigned

QUALIFICATIONS

Your Knowledge and Experience

• Requires a juris doctorate degree from a law school accredited by the American Bar Association or Committee of Bar Examiners of the State of California
• Requires active member of the California bar, or active licensee in good standing of a bar of a United States state or the District of Columbia who maintains Registered In-House Counsel status with the State Bar of California
• Requires a successful track record of at least five years of experience providing legal advice on relevant areas of the law (e.g., corporate, privacy, health care regulatory, litigation, contracts, et al) at a law firm or in-house health law department, including state or federal regulatory agency
• Requires excellent communication skills, both written and verbal, as well as relationship building skills to collaborate with and influence all relevant stakeholders, both internal and external
• Requires strong independent judgment, problem-solving, critical, and analytical thinking skills, including a “moral compass” and high integrity
• Requires ability to work with minimal supervision, to multi-task, and to deliver a high-quality work product in a highly regulated, demanding, and constantly changing corporate environment required
• Requires ability to lead when appropriate and to work both independently and collaboratively on teams
• Requires proficiency in Microsoft Word, Excel, PowerPoint, and Outlook
• Requires ability to communicate complex legal issues to non-lawyer clients and regulator staff
• A combination of law firm, in-house counsel and/or state regulator experience is preferred

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.

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.

• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.

• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.