Provider Contracting Specialist, Senior, Model Contracts

Job Title: Provider Contracting Specialist, Senior (Model Contracts)

The Model Contracts team manages and maintains Blue Shield of California's standardized provider agreement templates across multiple lines of business and risk arrangements. In this role, the individual will support the accuracy, consistency, and regulatory compliance of provider contract templates, enabling compliant and efficient provider contracting operations across the organization.

Our leadership model is about developing great contributors at all levels and creating opportunities for our people to grow personally, professionally, and financially. We are looking for professionals who are energized by analytical thinking, collaboration, attention to detail, and sustaining high-quality work through continuous improvement.

Responsibilities

In this role, you will:

• Maintain and update standardized provider contract templates used across Blue Shield of California
• Support contract templates covering multiple risk arrangements and product types, including shared, dual, and full risk; facility and medical group agreements; IPPA; and HMO and PPO products
• Coordinate cross-functional reviews of contract template updates with Legal, Mandate teams, and internal subject matter experts
• Incorporate legal, regulatory, and mandate-driven changes into approved template language
• Prepare and manage governmental filings for new or updated provider contract templates and track approval status
• Maintain accurate version control, documentation, and approval records for all model contract templates
• Serve as a resource to Provider Contracting and related teams regarding approved template language and appropriate usage
• Identify potential compliance risks or inconsistencies and escalate through established governance channels
• Support internal audit, compliance, and regulatory review requests related to provider contract templates

Qualifications

In this role, you will need:

• Bachelor's degree in Business, Healthcare Administration, Healthcare Policy, Public Health, or a related field, or equivalent experience
• Minimum of 5 years of relevant experience in healthcare contracting, contract administration, regulatory support, or a related role involving standardized agreement maintenance
• Knowledge of healthcare provider contracting concepts and managed care products
• Experience coordinating reviews with legal, regulatory, and business stakeholders
• Strong written and verbal communication skills with high attention to detail
• Strong organizational, prioritization, and documentation skills
• Proficiency with Microsoft Office applications; experience with contract management systems preferred

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 Us

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

• 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.