Contract Configuration Analyst: Claims Audit & Validation

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

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.