Configuration Analyst, Associate

Blue Shield of CA; Los Angeles (CA); Híbrido; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Blue Shield of California is seeking a Contract Configuration Analyst Associate within the QC Pricing Analytics team. You will perform in-line audits of negotiated provider contracts and run test claims to ensure accuracy of future payments per contract specifications.

You will validate contract builds, identify gaps, and assist with remediations while supporting continuous process improvements in a hybrid in-office setting.

Formación

• Bachelor's degree or equivalent experience is required.
• 0-2 years of prior relevant experience in this domain.
• 0-2 years of prior audit experience with BSC contracts.
• Strong medical claims knowledge and experience is essential.
• Knowledge of FACETS, CLMS, MS Office Suite is preferred.
• Previous auditing and claims processing experience in a health plan is desirable.

Responsabilidades

• Perform in-line audits for negotiated provider contracts.
• Run test claims to verify payments align with contract terms.
• Validate that contracts are built correctly per specifications and identify gaps.
• Support process improvements by addressing remediations.

Conocimientos

Analytical skills

Time management

Organizational skills

Team player

Exceptional problem solving

Customer service oriented

Educación

Bachelor's degree or equivalent experience

Herramientas

FACETS

CLMS

MS Office Suite

Descripción del empleo

Your Role

The QC Pricing Analytics and Contract Configuration team is responsible for performing an in-line audit for all negotiated provider contacts. The QC Configuration Analyst Associate will report to the QC Pricing Analytics Contract Configuration, Manager. In this role, you will conduct audits and run test claims to ensure future claims will be paid correctly based on the contractual terms. Validate that the negotiated provider contracts were built correctly and according to the contract's specification Support process improvements by identifying possible gaps and addressing remediations.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• 0-2 years of prior relevant experience
• 0-2 years of prior audit experience of auditing BSC contracts
• Requires strong medical claims knowledge and experience
• Knowledge of FACETS, CLMS, MS Office Suite
• Previous auditing experience and claims processing experience in a health plan
• Service (internal customers) oriented/philosophy in a diverse, demanding, and evolving environment with good analytical and problem-solving skills, time management, and organizational skills
• Excellent interpersonal skills and ability to act as a team player
  

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.