Configuration Analyst, Associate

Blue Shield of CA; San Diego (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Blue Shield of CA is seeking a Contract Configuration Analyst Associate to join the QC Pricing Analytics and Contract Configuration team in San Diego. You will perform in-line audits of negotiated provider contracts, run test claims, and verify payments align with contract terms.

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

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 mindset with strong analytical, time management and organizational skills.
• Excellent interpersonal skills and ability to act as a team player.

Responsibilities

• Conduct in-line audits for negotiated provider contracts.
• Run test claims to ensure future claims will be paid correctly based on the contract terms.
• Validate that contracts were built according to contract specifications.
• Identify gaps and remediation opportunities to support process improvements.

Skills

Medical claims knowledge

FACETS

CLMS

MS Office Suite

Interpersonal skills

Time management

Organizational skills

Education

Bachelor's degree or equivalent experience

Tools

Auditing tools

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.