Contract Configuration Analyst - Hybrid Audit & Claims

Blue Shield of CA; Los Angeles (CA); Hybrid; USD 65.000 - 90.000; Vollzeit

Zusammenfassung

Blue Shield of California is seeking a Contract Configuration Analyst Associate within the QC Pricing Analytics team. You will perform in-line audits of negotiated provider contracts and run test claims to ensure accuracy of future payments per contract specifications.

You will validate contract builds, identify gaps, and assist with remediations while supporting continuous process improvements in a hybrid in-office setting.

Qualifikationen

• Bachelor's degree or equivalent experience is required.
• 0-2 years of prior relevant experience in this domain.
• 0-2 years of prior audit experience with BSC contracts.
• Strong medical claims knowledge and experience is essential.
• Knowledge of FACETS, CLMS, MS Office Suite is preferred.
• Previous auditing and claims processing experience in a health plan is desirable.

Aufgaben

• Perform in-line audits for negotiated provider contracts.
• Run test claims to verify payments align with contract terms.
• Validate that contracts are built correctly per specifications and identify gaps.
• Support process improvements by addressing remediations.

Kenntnisse

Analytical skills

Time management

Organizational skills

Team player

Exceptional problem solving

Customer service oriented

Ausbildung

Bachelor's degree or equivalent experience

Tools

FACETS

CLMS

MS Office Suite

Jobbeschreibung

Blue Shield of California is seeking a Contract Configuration Analyst Associate within the QC Pricing Analytics team. You will perform in-line audits of negotiated provider contracts and run test claims to ensure accuracy of future payments per contract specifications.

You will validate contract builds, identify gaps, and assist with remediations while supporting continuous process improvements in a hybrid in-office setting.