Healthcare Contract Configuration Analyst - Associate Hybrid

Blue Shield of CA; San Diego (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Blue Shield of CA is seeking a Contract Configuration Analyst Associate to join the QC Pricing Analytics and Contract Configuration team in San Diego. You will perform in-line audits of negotiated provider contracts, run test claims, and verify payments align with contract terms.

This hybrid role requires 0-2 years of audit and claims experience, a bachelor’s degree or equivalent, and knowledge of FACETS, CLMS, and MS Office.

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 mindset with strong analytical, time management and organizational skills.
• Excellent interpersonal skills and ability to act as a team player.

Responsibilities

• Conduct in-line audits for negotiated provider contracts.
• Run test claims to ensure future claims will be paid correctly based on the contract terms.
• Validate that contracts were built according to contract specifications.
• Identify gaps and remediation opportunities to support process improvements.

Skills

Medical claims knowledge

FACETS

CLMS

MS Office Suite

Interpersonal skills

Time management

Organizational skills

Education

Bachelor's degree or equivalent experience

Tools

Auditing tools

Job description

Blue Shield of CA is seeking a Contract Configuration Analyst Associate to join the QC Pricing Analytics and Contract Configuration team in San Diego. You will perform in-line audits of negotiated provider contracts, run test claims, and verify payments align with contract terms.

This hybrid role requires 0-2 years of audit and claims experience, a bachelor’s degree or equivalent, and knowledge of FACETS, CLMS, and MS Office.