Provider Relations Representative, Senior

Provider Relations Representative, Senior

The Behavioral Health Network Management, Healthcare Quality and Affordability team is responsible for the state-wide behavioral health program at Blue Shield of California (BSC). This includes managing a directly contracted behavioral health provider network. The Provider Relations Representative, Senior will report to the Manager, Provider Services – Relations. In this role you will be one of several team members who will be leading the effort to reimagine how we deliver behavioral health services to our Commercial, Medicare, and Medi-Cal membership. This role combines provider support, issue resolution, relationship building, and administrative coordination to ensure a seamless provider experience.

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

In this role, you will:

• Answer high volumes of incoming provider calls and emails in a timely and professional manner
• Greet callers warmly and provide accurate, helpful information
• Handle general inquiries, complaints and concerns with poise and diplomacy
• Escalate complex or unresolved issues to the appropriate department or manager
• Maintain detailed call records and log provider interactions in the system
• Develop and maintain good working relationships with the provider community to resolve questions or problems such as contract interpretation and product/program implementation
• Ensure provider compliance with company policies, regulatory requirements, and contractual agreements
• Coordinate with project teams to identify potential network participants and promote provider participation in BSC programs and networks
• Assist with provider negotiations; may negotiate selected agreements
• Conduct orientations, training, and education to the provider community as needed
• Collaborate with project teams to send out contracting packets
• Prioritize work in dedicated project mailboxes based on current business needs
• Receive and process contracting documents to ensure completeness, accurate tracking, and required reporting
• Make outreach calls to providers when needed to obtain missing information and documentation
• Perform screenings for Medi-Cal and Medicare enrollment and credentialing status

Qualifications

In this role, you will need:

• A college degree or equivalent experience
• Five years of prior relevant experience
• Strong customer service and problem-solving skills
• Strong analytical skills
• Strong time management and organizational skills
• Self-starter who works well independently or with a team
• Excellent written and verbal communication skills
• Proficiency in Outlook, Word, Excel, and Adobe Acrobat

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

About Us

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.