Configuration Analyst, Associate

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

Job summary

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

The role emphasizes collaboration, problem solving, and continuous improvement, with a focus on accuracy, attention to detail, and strong claims knowledge to support operational excellence.

Qualifications

• Requires 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.
• Previous auditing experience and claims processing experience in a health plan.
• Service-oriented with analytical, problem-solving, time management, and organizational skills.
• Excellent interpersonal skills and ability to act as a team player.

Responsibilities

• Perform in-line audits for negotiated provider contracts.
• Run test claims to ensure future claims pay per contractual terms.
• Validate negotiated contracts against contract specifications.
• Identify gaps and address remediations to support process improvements.

Skills

Medical claims knowledge

Analytical problem solving

Time management

Organizational skills

Interpersonal skills

Team player

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.