Configuration Analyst, Associate

Blue Shield of CA; Oakland (CA); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Blue Shield of CA is seeking a QC Pricing Analytics Contract Configuration Analyst Associate to perform in-line audits of negotiated provider contracts. You will audit and run test claims to ensure future payments align with contractual terms and validate that contracts were built correctly.

This hybrid role requires 0-2 years of relevant audit or claims processing experience, a bachelor’s degree or equivalent, and knowledge of FACETS, CLMS, and MS Office Suite.

Qualifications

• Bachelor's degree or equivalent experience
• 0-2 years of prior relevant experience
• 0-2 years of prior audit experience of auditing BSC contracts
• 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-oriented with analytical and problem-solving skills, time management and organizational skills
• Excellent interpersonal skills and ability to act as a team player

Responsibilities

• Conduct audits and run test claims to ensure future claims will be paid correctly based on 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

Skills

Medical claims knowledge

Analytical skills

Problem solving

Time management

Organizational skills

Interpersonal skills

Team player

Customer service orientation

Strong communication

Education

Bachelor's degree or equivalent experience

Tools

FACETS

CLMS

MS Office Suite

Job description

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.