Senior Behavioral Health Provider Relations Specialist

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

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