Provider Relations Representative, Senior
Blue Shield of CA, Rancho Cordova, CA, United States
Your Role
The Provider Relations team oversees provider relationships and serves as the primary liaison between Blue Shield of California (BSC) and our contracted provider network. Our role is to support providers through education, issue resolution, and operational guidance, enabling them to effectively navigate our processes and consistently deliver high-quality care to our members.
The Provider Relations Representative, Senior will report to the Sr. Manager, Provider Contracting. In this role, you will be responsible for building and maintaining effective provider relationships with IPA/medical groups, PPO physicians, and hospitals, for all lines of business. This role entails delivering established quantifiable goals and targets for the assigned network of providers. Including the servicing of the designated provider network in the operational and compliance aspects of provider contracts. Additionally, you will interface daily with providers and internal constituents to effectively resolve service issues in a timely manner.
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.
Your Knowledge and Experience
Requires a college degree or equivalent experience
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 regulatory requirements is preferred
Knowledge of delegation and oversight
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.
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The Provider Relations Representative, Senior will report to the Sr. Manager, Provider Contracting. In this role, you will be responsible for building and maintaining effective provider relationships with IPA/medical groups, PPO physicians, and hospitals, for all lines of business. This role entails delivering established quantifiable goals and targets for the assigned network of providers. Including the servicing of the designated provider network in the operational and compliance aspects of provider contracts. Additionally, you will interface daily with providers and internal constituents to effectively resolve service issues in a timely manner.
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.
Your Knowledge and Experience
Requires a college degree or equivalent experience
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 regulatory requirements is preferred
Knowledge of delegation and oversight
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.
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