Contract Config Analyst Associate – Claims Audit (Hybrid)

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 70,000 - 90,000; Full time

Job summary

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

The role requires 0-2 years of audit experience and strong medical claims knowledge, with familiarity in FACETS, CLMS, and MS Office. This position operates in a hybrid model with in-office two days per week.

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.
• Requires strong medical claims knowledge and experience.
• Knowledge of FACETS, CLMS, MS Office Suite.
• Previous auditing and claims processing experience in a health plan.
• Service oriented with strong analytical, 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 are paid correctly based on contract terms.
• Validate that negotiated provider contracts were built correctly per specifications.
• Support process improvements by identifying gaps and addressing remediations.

Skills

Medical claims knowledge

Analytical thinking

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

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

The role requires 0-2 years of audit experience and strong medical claims knowledge, with familiarity in FACETS, CLMS, and MS Office. This position operates in a hybrid model with in-office two days per week.