Provider Relations Representative, Senior

Blue Shield of CA; Lodi (CA); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Shield of California is seeking a Senior Provider Relations Representative to strengthen our provider network, ensure contract compliance, and collaborate with internal teams to resolve operational issues.

The role emphasizes building relationships, strategic thinking, and delivering results with integrity while navigating CA-specific regulatory requirements.

Qualifications

• Bachelor's degree or High School/GED plus 4 years of relevant experience.
• 5 years of prior relevant experience.
• Experience working at a health plan (managed care, government payer, or academic).
• Experience working directly with CA provider networks.
• Strong organizational and time management skills.
• Ability to manage multiple initiatives.
• Ability to present in group settings.
• Ability to independently drive issues to resolution and multi-task.
• Knowledge of regulatory requirements is preferred.
• Knowledge of delegation and oversight.

Responsibilities

• Build provider relationships and support contract compliance.
• Partner with providers and internal teams to resolve operational issues and achieve network goals.

Skills

5 years of relevant experience

Experience with health plans

CA provider networks

Organizational skills

Time management

Multi-tasking

Presentation skills

Issue resolution

Regulatory knowledge

Delegation & oversight

Education

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

Job description

Your Role

The Provider Relations team serves as the primary liaison between Blue Shield of California and its provider network, supporting providers through education, guidance, and issue resolution.

The Senior Provider Relations Representative builds provider relationships, supports contract compliance, and partners with providers and internal teams to resolve operational issues and achieve network goals.

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

• Requires a bachelor's degree or High School/GED plus 4 years of relevant experience
• Requires 5 years of prior relevant experience
• Requires experience working at a health plan (managed care, government payer, or academic)
• Requires experience working directly with provider networks of CA.
• Strong organizational and time management skills
• Ability to manage multiple initiatives
• Ability to present in group settings
• Ability to independently drive issues to resolution and multi-task
• Knowledge of regulatory requirements is preferred
• Knowledge of delegation and oversight

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.