Provider Relations Representative, Senior

Job DescriptionYour RoleThe Provider Relations team serves as the intermediary between Blue Shield of California and the IPA/medical groups, hospitals, and PPO physicians in which they are responsible for maintaining long-term relationships with. The Provider Relations Representative, Senior is responsible for building relationships with IPA/medical groups, PPO physicians, and hospitals for all lines of business. This role entails delivering established quantifiable goals and targets for an assigned provider network of providers, and services the designated provider network in operational and compliance aspects of provider contracts. Reporting to the Manager, Provider Services, this role will work with providers and internal constituents to resolve service issues promptly and effectively. The ability to present in group settings and independently drive issues to resolution as well as effective multi-tasking skills that are critical for success.ResponsibilitiesYour work: In this role, you will:Develop and maintain deep and long-lasting relationships with providersCoordinate escalated claim disputes and all necessary research in a timely and effective mannerImplement or support at least three geo-regional strategies with minimal support and guidance from the managerCoordinate data extracts and data analysis interpretation in preparation of reports to determine the necessity of rate increases to retain key PPO providers, with minimal support and guidance from the managerConduct data-driven operations meetings with an assigned provider network, including IPA/medical groups, PPO providers/provider groups, and hospitals. Demonstrate the ability to drive critical discussions with an assigned network of providers to deliver established quantifiable goals and targetsSupport assigned provider book of business in a customer-focused, effective, and efficient mannerDrive focused strategic outreach with Providers to ensure compliance with Accessibility and Availability, and ensure that New Provider Orientation within state and federal regulations are met Implement strategies with providers to improve provider performance. Customize special education needs for providers and deliver strategic communications to assigned providers with minimal guidanceExecute crucial provider performance metrics by demonstrating quantifiable improvements that contribute to Blue Shield of California's critical strategic goals, including but not limited to reducing network utilization to decrease the overall cost of healthcareQualificationsYour Knowledge and ExperienceRequires a college degree or equivalent experienceRequires 5 years of prior relevant experienceStrong organizational and time management skillsAbility to manage multiple initiativesKnowledge of Provider Networks in CaliforniaAppropriate knowledge of delegation and oversightKnowledge of regulatory requirements is preferred About the TeamAbout Blue Shield of CaliforniaAs 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:At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.Two Ways of Working: Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:o Member-facing and approved out-of-state roles remain remote.o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.o 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. On-Site: Work from a business unit-approved office an average of four (4) or more days a week.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.