Contract Configuration Analyst — Pricing & Claims Audit (Hybrid)

Blue Shield of CA; Long Beach (CA); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Blue Shield of CA in Long Beach is seeking a QC Pricing Analytics Contract Configuration Analyst Associate to perform in-line audits of negotiated provider contracts and to run test claims ensuring future payments align with contract terms.

You will validate contract builds, identify gaps, and support remediation efforts, reporting to the Contract Configuration Manager. This role emphasizes analytical problem solving, collaboration, and continuous improvement in a hybrid office setting.

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 with good 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 are paid correctly per contract terms.
• Validate contracts were built correctly according to specifications.
• Support process improvements by identifying gaps and addressing remediations.

Skills

Medical claims knowledge

Analytical

Team player

Problem-solving

Hybrid work adaptability

Education

Bachelor's degree or equivalent experience

Tools

FACETS

CLMS

MS Office Suite

Job description

Blue Shield of CA in Long Beach is seeking a QC Pricing Analytics Contract Configuration Analyst Associate to perform in-line audits of negotiated provider contracts and to run test claims ensuring future payments align with contract terms.

You will validate contract builds, identify gaps, and support remediation efforts, reporting to the Contract Configuration Manager. This role emphasizes analytical problem solving, collaboration, and continuous improvement in a hybrid office setting.