Provider Relations Representative, Experienced

Blue Shield of CA; San Diego (CA); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Blue Shield of CA is seeking a Provider Relations Representative, Experienced to support provider participation and engagement for the CalAIM program. This role reports to the Director, Provider Services - Relations and aims to improve provider experiences and outcomes.

Hybrid work model requires in-office presence with two days per week in the office, with adjustments based on business needs. Strong analytical and healthcare knowledge are essential.

Qualifications

• Bachelor's degree or high school diploma with 4 years of relevant experience in lieu of a degree.
• 3 years of prior relevant experience.
• Strong analytical, critical thinking, and problem-solving skills.
• Proficient in Microsoft Office applications, including Excel, Word, Access, and Outlook.
• Working knowledge of medical terminology and healthcare industry concepts.
• Experience with Medi-Cal, Medicaid, or similar government-sponsored programs preferred.
• Ability to work independently, prioritize multiple assignments, and manage responsibilities with minimal supervision.
• Excellent organizational skills with strong attention to detail and accuracy.

Responsibilities

• Support provider participation and engagement for CalAIM.
• Build and maintain provider relationships with IPA/Medical groups, Providers and Hospitals.
• Contribute to the success of the CalAIM program and improve provider experiences.
• Help drive health equity and better outcomes across communities.

Skills

Analytical

Critical thinking

Problem solving

Independent worker

Organizational skills

Attention to detail

Education

Bachelor's degree

High School Diploma or GED

Tools

Microsoft Office

Excel

Access

Outlook

Job description

Your Role

The Provider Services team is responsible for building and maintaining effective provider relationships with IPA/Medical groups, Providers and Hospitals. The Provider Relations Representative, Experienced will report to the Director, Provider Services - Relations. In this role you will play a key part in ensuring the success of the California Advancing and Innovating Medi-Cal (CalAIM) program by supporting provider participation and engagement. This position offers an opportunity to make a meaningful difference in the healthcare system by supporting providers in delivering coordinated, high-quality care to Medi-Cal members. Through your contributions, you will help drive program success, improve provider experiences, and support initiatives that promote health equity and better outcomes across the communities.

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

• 3 years of prior relevant experience
• Strong analytical, critical thinking, and problem-solving skills with the ability to identify issues and develop effective solutions.
• Proficient in Microsoft Office applications, including Excel, Word, Access, and Outlook.
• Working knowledge of medical terminology and healthcare industry concepts.
• Experience working with Medi-Cal, Medicaid, or other government-sponsored healthcare programs preferred.
• Demonstrated ability to work independently, prioritize multiple assignments, and manage responsibilities with minimal supervision.
• Excellent organizational skills with strong attention to detail and accuracy.

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.