Contract Configuration Analyst Associate – Hybrid & Claims Audit

Blue Shield of CA; Redding (CA); Hybrid; USD 65,000 - 88,000; Full time

Job summary

Blue Shield of CA is seeking a QC Pricing Analytics and Contract Configuration Associate to perform in-line audits of negotiated provider contracts and validate claim payments against contract terms.

You will audit contracts, run test claims, and identify gaps to support remediation and process improvements. The role emphasizes collaboration, leadership development, and continuous learning within a hybrid work model.

Qualifications

• 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 oriented/philosophy in a diverse environment with good analytical and problem-solving skills, time management, and organizational skills.
• Excellent interpersonal skills and ability to act as a team player.

Responsibilities

• Perform in-line audits for all negotiated provider contracts.
• Audit and run test claims to ensure future claims are paid correctly based on contract terms.
• Validate contracts were built correctly according to specifications.
• Identify gaps and drive remediation to support process improvements.

Skills

Medical claims knowledge

FACETS

CLMS

MS Office Suite

Analytical skills

Time management

Interpersonal skills

Education

Bachelor's degree or equivalent experience

Job description

Blue Shield of CA is seeking a QC Pricing Analytics and Contract Configuration Associate to perform in-line audits of negotiated provider contracts and validate claim payments against contract terms.

You will audit contracts, run test claims, and identify gaps to support remediation and process improvements. The role emphasizes collaboration, leadership development, and continuous learning within a hybrid work model.