Senior Provider Relations Liaison: Network Growth

Blue Shield of California; California (MO); Hybrid; USD 82,000 - 123,000; Full time

Job summary

Blue Shield of California is seeking a Senior Provider Relations Representative to strengthen relationships with its provider network. You will lead provider performance initiatives, coordinate issue resolution, and collaborate across internal teams to support contracts and network goals.

The role emphasizes data-driven decision making, regulatory compliance, and developing long-lasting provider partnerships while advancing the company mission to deliver high-quality, accessible care.

Qualifications

• 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.

Responsibilities

• Implement strategies with providers to improve provider performance.
• Customize special education needs for providers as well as delivering strategic communications to assigned providers with minimal guidance.
• Coordinate escalated claim disputes and all necessary research timely and effectively.
• Implement or support at least three geo-regional strategies with minimal support and guidance from your manager.
• Coordinate data extracts and data analysis interpretation in preparation of reports aimed at determining the necessity of rate increases to retain key PPO providers, with minimal support and guidance from manager.
• Conduct data driven operations meetings with assigned network of providers which includes IPA/medical groups, PPO providers/provider groups and Hospitals.
• Drive critical discussions with assigned network of providers to deliver established quantifiable goals and targets.
• Support assigned provider book of business in a customer-focused, effective and efficient manner.
• Develop and maintain deep and long-lasting relationships with providers.
• Drive focused strategic outreach with Providers to ensure compliance with Accessibility and Availability within state and federal regulations are met.
• Emphasize on improving member’s experience and perception in Getting Needed Care and Getting Care Quickly to help achieve Blue Shield of California’s (BSC’s) mission to meet a Medicare STAR 4 (or better) rating.
• Execute on key provider performance metrics by demonstrating quantifiable improvements that contribute to BSC's critical few strategic goals, including but not limited to reducing Out of Network utilization to decrease the overall Cost of Healthcare

Skills

Provider network experience

Group presentations

Data analysis

Regulatory knowledge

Project management

Education

Bachelor’s degree or GED + 4 years experience

Job description

Blue Shield of California is seeking a Senior Provider Relations Representative to strengthen relationships with its provider network. You will lead provider performance initiatives, coordinate issue resolution, and collaborate across internal teams to support contracts and network goals.

The role emphasizes data-driven decision making, regulatory compliance, and developing long-lasting provider partnerships while advancing the company mission to deliver high-quality, accessible care.