Provider Contracting Specialist, Consultant

Blue Shield of CA; Los Angeles (CA); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Blue Shield of California is seeking a Provider Contracting Specialist, Consultant to manage a portfolio of provider negotiations and contracting initiatives across California. You will independently handle complex negotiations from strategic analysis through execution, ensuring alignment with contracting strategies and approvals.

The role emphasizes affordability, network access, and cross-functional collaboration.

Qualifications

• Bachelor's degree (or equivalent) required with 4 years of relevant experience in lieu of degree.
• 7 years of prior relevant experience in provider contracting and negotiation preferred.
• Advanced knowledge of provider contracting, reimbursement methodologies, and contract language preferred.
• Experience with managed care operations and implications of provider agreements preferred.
• Ability to interpret data, evaluate alternatives, and translate analysis into recommendations.
• Strong portfolio-management skills for multiple negotiations and milestones.

Responsibilities

• Execute an assigned portfolio of provider negotiations and contracting initiatives.
• Independently manage complex negotiations from analysis to execution and resolution.
• Collaborate across the organization to advance affordability, network access, and business objectives.
• Ensure work aligns with contracting strategies, policies, controls, and approval requirements.
• Proactively identify risks and escalate issues requiring broader policy or executive decisions.

Skills

Provider contracting

Negotiation experience

Data interpretation

Financial impact analysis

Portfolio management

Project management

Cross-functional collaboration

Education

Bachelor's degree or High School Diploma/GED with 4 years of relevant experience

Job description

Your Role

The Provider Network Management team is responsible for provider contracting and network performance across California. The Provider Contracting Specialist, Consultant is accountable for executing an assigned portfolio of provider negotiations and contracting initiatives within the statewide strategies, governance standards, priorities, and escalation framework established by contracting leadership.

In this role, you will independently manage complex provider negotiations and contracting initiatives from strategic and financial analysis through execution, implementation, and issue resolution. You will partner across the organization to advance affordability, network access, and business objectives while ensuring work is executed within established contracting strategies, policies, controls, and approval requirements. You will be accountable for the timely execution and performance of your assigned portfolio, proactively identifying risks and escalating matters requiring broader policy, resource, or executive decisions.

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

• Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree required
• 7 years of prior relevant experience required
  Previous experience with provider contracting and negotiation experience, including experience managing complex negotiations and provider contracting processes preferred
• Advanced working knowledge of provider contracting, reimbursement methodologies, provider contract language, financial impact analysis, and provider network management preferred
• Working knowledge of managed care operations and the financial, operational, legal, regulatory, and member implications of provider agreements preferred
• Demonstrated ability to interpret data, evaluate alternatives, develop negotiation strategies, and translate analysis into practical recommendations preferred
• Strong project and portfolio-management skills, including the ability to manage multiple negotiations, milestones, dependencies, and competing priorities 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.