Strategic Provider Contracts Specialist

Blue Shield of California; California; Hybrid; USD 112,000 - 167,000; Full time

Job summary

Blue Shield of California is seeking a Provider Contracting Specialist, Consultant to manage a portfolio of provider negotiations and contracting initiatives across California. The role involves strategic and financial analysis, execution, and issue resolution to advance affordability and network access within established policies.

You will partner with Medical Management, Network Analytics, Legal, and Operations to ensure timely execution and meet contracting commitments.

Qualifications

• Bachelor's degree or equivalent required; 4 years of additional relevant experience in lieu of a degree acceptable.
• 7 years of prior relevant experience; provider contracting and negotiation experience preferred.
• Advanced working knowledge of provider contracting, reimbursement methods, contract language, financial impact analysis, and network management preferred.
• Understanding of managed care operations and implications of provider agreements preferred.
• Ability to interpret data, evaluate options, develop negotiation strategies, and translate analysis into practical recommendations.
• Strong project and portfolio-management skills to handle multiple negotiations and milestones.

Responsibilities

• Lead assigned provider negotiations and renewals through contract execution and implementation.
• Develop negotiation strategies, financial analyses, business cases, term sheets, and contract recommendations with leadership review.
• Manage contracting activities, milestones, risks, dependencies, and implementation requirements to ensure timely execution.
• Partner cross-functionally with Medical Management, Provider Relations, Network Analytics, Pricing, Underwriting, Legal, Operations, and Sales to support affordability and business objectives.
• Identify opportunities in network, reimbursement, utilization, and unit-cost within providers and suggest actionable steps to leadership.
• Investigate and resolve provider, contract, and implementation issues within delegated authority, escalating material risks as needed.
• Apply established contracting policies, templates, controls, and approval requirements consistently.

Skills

Provider contracting

Negotiation

Analysis

Project management

Cross-functional collaboration

Education

Bachelor's degree or equivalent

Job description

Blue Shield of California is seeking a Provider Contracting Specialist, Consultant to manage a portfolio of provider negotiations and contracting initiatives across California. The role involves strategic and financial analysis, execution, and issue resolution to advance affordability and network access within established policies.

You will partner with Medical Management, Network Analytics, Legal, and Operations to ensure timely execution and meet contracting commitments.