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$82k–$139k/yr
Full-time
high school, bachelor degree
Health insurance, Professional development opportunities, Financial growth opportunities
Posted 2d ago
Apply by Sep 14
~40 hrs/week
Responsibilities
The Provider Relations Representative serves as a primary liaison between the company and its provider network to support education, guidance, and issue resolution. They are responsible for building provider relationships, ensuring contract compliance, and driving operational performance to meet network goals.
Requirements
The role requires a Bachelor’s degree or a High School Diploma/GED with 4 years of relevant experience, plus 5 years of prior relevant experience. Candidates must possess strong organizational skills, knowledge of California provider networks, and the ability to manage multiple initiatives independently.
Full job description
Your Role
The Provider Relations team serves as the primary liaison between Blue Shield of California (BSC) and its provider network, supporting providers through education, guidance, and issue resolution. The Provider Relations Representative, Senior will report to the Manager, Provider Services-Relations and be responsible for building provider relationships, supporting contract compliance, and partnering with providers and internal teams to resolve operational issues and achieve network goals.
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:
Implement strategies with providers to improve provider performance
Customize special education needs for providers as well as delivering strategic communications to assigned providers with minimal guidance
Coordinate escalated claim disputes and all necessary research timely and effectively
Implement or support at least three geo-regional strategies with minimal support and guidance from your manager
Coordinate data extracts and data analysis interpretation in preparation of reports aimed at determining the necessity of rate increases to retain key PPO providers, with minimal support and guidance from your manager
Conduct data driven operations meetings with assigned network of providers which includes IPA/medical groups, PPO providers/provider groups and Hospitals
Drive critical discussions with assigned network of providers to deliver established quantifiable goals and targets
Support assigned provider book of business in a customer-focused, effective and efficient manner
Develop and maintain deep and long-lasting relationships with providers
Drive focused strategic outreach with Providers to ensure compliance with Accessibility and Availability within state and federal regulations are met
Emphasize on improving member’s experience and perception in Getting Needed Care and Getting Care Quickly to help achieve Blue Shield of California’s (BSC’s) mission to meet a Medicare STAR 4 (or better) rating
Implement strategies with providers to improve provider performance
Customize special education needs for providers as well as delivering strategic communications to assigned providers with good level of self-reliance
Execute on key provider performance metrics by demonstrating quantifiable improvements that contribute to BSC's critical few strategic goals, including but not limited to reducing Out of Network utilization to decrease the overall Cost of Healthcare
Qualifications
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 5 years of prior relevant experience
Strong organizational and time management skills
Ability to manage multiple initiatives
Ability to present in group settings
Ability to independently drive issues to resolution and multi-task
Knowledge of Provider Networks in California
Knowledge of delegation and oversight
Knowledge of regulatory requirements 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.
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.
Ascendiun is a nonprofit and ultimate parent company of Blue Shield of California, Blue Shield Promise Health Plan, Altais and Stellarus. The Ascendiun family of companies are dedicated to advancing better health outcomes, making care more affordable and addressing the unique needs of diverse communities.
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