Your Role

The Provider Operations team manages Blue Shield’s network of physicians, IPA / Medical groups, hospitals, and specialty healthcare providers.

The Provider Processor will report to the Operations Supervisor. In this role you will work independently and demonstrate strong organization and prioritization skills, respond to various provider inquires.

Apply standard operating procedures and guidelines. Resolve all inquiries within established timeliness and quality standards.

Processors must have the ability to communicate professionally with internal and external customers. As an individual contributor our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow personally, professionally, and financially.

Your Work

In this role, you will :

• Apply defined procedures and policies to accurately maintain provider file maintenance in the Provider Manager application.
• Complete Provider inquiries or updates related to Blue Shield of California and / or Blue Shield of California Promise Health Plan networks.
• Coordinate with other departments to ensure timely and appropriate responses are completed.
• Communicate with internal / external business partners regarding contractual responsibilities, policies, and procedures.
• Consistently performs established duties that are measurable metrics by internal SLA’s or mandated turnaround times.
• Continually performing research and applying critical thinking, meet or exceed daily goals, while maintaining a high- level quality of work.

Last updated : 2024-05-23