Contract Configuration Lead - Remote (Health Plan)

SCAN Group; Long Beach (CA); Remote; USD 92,000 - 134,000; Full time

Benefits offered by this job

Mostly Remote

Annual bonus program

Wellness program

Paid time off (PTO)

11+ holidays per year + floating/birth

401(k) with employer match

Employee recognition program

Tuition reimbursement

Job summary

SCAN Health Plan in Long Beach, CA seeks a Configuration Program Lead - Contracts to manage complex contract-related configuration initiatives (DOFR, NCN) and translate contractual requirements into accurate system configuration.

You will coordinate implementation, validation, testing, and issue resolution with cross-functional teams, and maintain governance and change-management processes to ensure compliance.

Qualifications

• Bachelor's Degree or equivalent experience.
• 5 years of experience in healthcare payer operations, health plan configuration, provider contract administration, network operations, claims administration, or a related field.
• Experience translating contractual and operational requirements into system configuration, coordinating testing and implementation activities, and partnering with cross-functional stakeholders to support accurate configuration processes.
• Ability to interpret and translate complex contract, provider network, and operational requirements into accurate system configuration and business rules.
• Strong knowledge of configuration implementation, testing, validation, and change management practices to ensure configuration accuracy and compliance.
• Ability to collaborate effectively with cross-functional stakeholders, including Network Management, Provider Operations, Claims, Legal, Compliance, IT, and business partners to resolve issues and achieve operational objectives.
• Strong analytical and problem-solving skills with the ability to identify configuration risks, dependencies, process improvement opportunities, and automation solutions.
• Advanced Microsoft Office Suite, SQL, and Visio skills are required.

Responsibilities

• Lead configuration activities associated with DOFR, NCN, and other contract-related requirements.
• Interpret approved contract terms and operational requirements and translate them into accurate system configuration.
• Coordinate implementation, validation, testing, and issue resolution associated with new or modified contract configuration.
• Partner with Network Management, Provider Operations, Claims, Legal, Compliance, IT, and other business partners to resolve configuration questions and discrepancies.
• Maintain governance, documentation, controls, and change-management processes for contract configuration.
• Identify configuration risks, dependencies, and opportunities for process improvement, standardization, and automation.
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN's Vision and Goals.
• Other duties as assigned.

Skills

Analytical thinking

Cross-functional collaboration

SQL

Microsoft Office

Visio

Education

Bachelor's Degree or equivalent experience

Tools

Microsoft Office

SQL

Visio

Job description

SCAN Health Plan in Long Beach, CA seeks a Configuration Program Lead - Contracts to manage complex contract-related configuration initiatives (DOFR, NCN) and translate contractual requirements into accurate system configuration.

You will coordinate implementation, validation, testing, and issue resolution with cross-functional teams, and maintain governance and change-management processes to ensure compliance.