Provider Relations Representative, Senior - Behavioral Health Call Center

Blue Shield of California; United States; Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Hybrid work model

Professional development opportunities

Job summary

Blue Shield of California is seeking a Senior Provider Relations Representative to support the Behavioral Health Network Management team. The role focuses on provider support, issue resolution, and coordinating administrative tasks to deliver a seamless provider experience in a high-volume call center.

You will handle provider calls and emails, escalate complex issues, maintain accurate records, and build relationships with the provider community across Commercial, Medicare, and Medi-Cal

Qualifications

• Bachelor’s degree or HS diploma with 4 years related experience.
• 5 years in a managed care setting interacting with providers by phone.
• Excellent written and verbal communications.
• Strong analytical, time management, and organizational skills.
• Proficiency in Outlook, Word, Excel, and Adobe Acrobat.
• Self-starter who works well independently or with a team.

Responsibilities

• Work in a call center environment, handling high-volume provider calls.
• Answer provider emails and resolve inquiries with poise and diplomacy.
• Escalate complex issues to the appropriate department or manager.
• Maintain detailed call records and provider interactions in the system.
• Develop relationships with the provider community to resolve questions.
• Ensure provider compliance with policies, regulatory requirements, and contracts.
• Coordinate with project teams to promote provider participation in programs.
• Assist with provider negotiations and conduct orientations and trainings.
• Process contracting documents and report on required metrics.
• Make outreach calls to obtain missing information and documentation.
• Screen Medi-Cal and Medicare enrollment and credentialing status.

Skills

Call center experience

Customer service

Verbal communication

Written communication

Analytical skills

Education

Bachelor’s degree

High School Diploma/GED

Tools

Outlook

Word

Excel

Adobe Acrobat

Job description

Your Role

The Behavioral Health Network Management 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 Behavioral Health Provider Relations Manager. 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 behavioral health call center 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.

Your Work

• Work in a call center environment throughout the workday, continuously answering a high volume of incoming provider calls routed through an assigned call queue


• Work in a group mailbox answering a high volume of provider emails


• Handle general inquiries, complaints and concerns with poise and diplomacy in a timely and professional manner and provide accurate, helpful information


• 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

Your Knowledge and Experience

• Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree


• Requires 5 years of prior relevant experience working in a managed care setting and interacting regularly with providers over the phone


• Excellent written and verbal communications skills


• Strong analytical skills, time management skills, and organizational skills


• Strong customer service and problem‑solving skills


• Proficiency in Outlook, Word, Excel, and Adobe Acrobat


• Self‑starter who works well independently or with a team

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.