Provider Network Specialist

Workforce Classification:

Telecommuter

 

Join Our Team: Do Meaningful Work and Improve People’s Lives 

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.premera.com/.

As a Provider Network Specialist, you will be responsible for the maintenance of all professional and institutional providers, including national network provider information within the provider source systems and other applicable systems. You will research and update provider demographic information timely and accurately for directories, provider mailings and claims payment and act as a liaison between Premera Blue Cross and its providers.

What you’ll do: 

• Ensure data integrity of provider directories for all markets including all demographic, specialty, credentialing, and both contractual and non-network participation.
• Provide timely, accurate, and concise responses to inquiries made by internal departments and providers related to networks, contract information, agreement ID’s, claims, payment methods, on-line directory, provider mailings, and national networks.
• Research and resolve provider inquiries and complex claims issues relating to provider information by investigation/review within department standards/processes.
• Assure compliance with the National Committee for Quality Assurance (NCQA), Office of the Insurance Commissioner (OIC), and other regulatory agencies/requirements.
• Process incoming provider information updates and contract implementation requests, utilizing different applications and websites (ex. vendor databases, licensing website) and complete the necessary updates into the provider source system.
• Verify provider information for In Network and Out of Network providers (including but not limited to demographic information, remittance, location address, licensure etc.), utilizing applicable resources (ex. phone, email, vendor databases etc.).
• Coordinate with internal departments, such as Care Management, Claims, Customer Service, and Systems and Reporting to answer questions and resolve provider related problems.
• Assist customer service with inquiries and unique provider issues.
• Maintain accurate and complete electronic documentation on all provider correspondence.
• Provide support for Provider Network Executives (PNEs) and provider network.
• Provide input on improvements regarding workflow, procedures, or policies, and make recommendations to management.

What you’ll bring: 

• High School Diploma or GED. (Required)
• (3) years of experience in a production or customer service environment requiring attention to detailed procedures. (Required)
• Minimum of one year of hands-on experience in healthcare administration, including provider data management responsibilities.
• Knowledge of other internal department operations or functions that assist in resolution of provider inquiries.
• Knowledge of medical and/or medical insurance terminology.
• Experience in working with Microsoft Word and Excel.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.

• Life and disability insurance.

• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

• Generous paid time off to reenergize.

• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

• Free convenient on-site parking.

• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

$47,100.00 - $70,700.00

National Plus Salary Range:

$53,700.00 - $80,600.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.