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JOB DESCRIPTION
Your Role

The Provider Relations Representative, Senior will report to the Manager, Provider Services-relations. In this role you will be responsible for building and maintaining effective provider relationships with IPA/Medical groups, PPO Physicians and Hospitals. This entails services in the operational and compliance aspects of provider contact. Daily interface with providers to effectively resolve service issues in a timely manner is a requirement.

Your Work

In this role, you will:

• 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 manager
• Coordinate data extracts and data analysis interpretation in preparation of reports aimed to determine necessity of rate increases to retain key PPO providers, with minimal support and guidance from manager
• Develops new perspectives and approaches on existing problems
• Communicates with parties within and outside of own department, with the ability to educate/train others on complex disciplines
• May be responsible for providing guidance, coaching, and training to other employees within job area
• May manage projects requiring the responsibility of delegating work and reviewing resulting work product
• Other duties as assigned

QUALIFICATIONS
Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 5 years of prior relevant experience
• Strong analytical and problem-solving skills
• Requires advanced knowledge of job area typically obtained through advanced education combined with experience
• Practical knowledge of project management
• Previous experience with Medi-Cal or Medicaid
• Proficiency in Microsoft Office Suite (Excel, Outlook, Access & Word)

Pay Range

The pay range for this role is: $ 75,680.00 to $ 113,520.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.