Blue Cross NC · 23 hours ago
Director, Provider Service
United States
Full-time
Remote
Senior Level, Lead/Staff
$144K/yr - $230K/yr
10+ years expBlue Cross NC is a leading health care organization focused on delivering high-quality services. The Director of Provider Service will shape the strategic vision for provider customer service, guiding team leaders and driving initiatives to enhance performance and service standards.
Financial ServicesHealth InsuranceInsurance
Responsibilities
Develop the strategic vision and key processes for the provider contact center, prioritizing support delivered through vendors, plan-to-plan, and PSA contact channels by business impact
Partner with Operational leads and workforce management to supplement strategy with the development of budgets, staffing models, and operational performance standards
Direct and improve Strategic Provider Services offering, maintaining close relationships with key (Platinum) providers including use of site visits to inform provider service strategy and resolve escalated claims and service issues
Oversee support of non-platinum providers through virtual contact centers while providing oversight for vendor relations. Ensure plan-to-plan contacts are handled in line with BCBSA standards and service level expectations
Communicating with managers and team leads on the provider service strategy and align on operational changes necessary for execution
Resolve complex escalations and contribute to training development to maintain and improve service delivery
Monitor and review service performance ensuring that provider service agreements are met
Report operational updates to the Claims AVP and Operations VP; serve as a subject matter expert for provider service
End to end inventory management to align with all regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting all processing guidelines as required to meet customer expectations
Qualification
Required
Bachelor's degree or advanced degree (where required)
10+ years' experience in Health Care Delivery and Operations
In lieu of degree, 12+ years of experience in related field
Deep health plan claims and service expertise
5+ years of progressive leadership experience
Preferred
Strong analytical skills with the ability to drive transformational, consumer centric change while managing operations – highly preferred
Six Sigma/Continuous improvement experience - highly preferred
Benefits
Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution.
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Tunde Sotunde
President and Chief Executive Officer
Caleb Davies
Medicaid Market CFO - Healthy Blue of NC Medicaid
Recent News
2026-01-06
Arkansas Business — Business News, Real Estate, Law, Construction
2025-10-31
Company data provided by crunchbase