Hybrid Claims & Contract Configuration Analyst

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

Job summary

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

The role emphasizes collaboration, problem solving, and continuous improvement, with a focus on accuracy, attention to detail, and strong claims knowledge to support operational excellence.

Qualifications

• Requires 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.
• Previous auditing experience and claims processing experience in a health plan.
• Service-oriented with 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 pay per contractual terms.
• Validate negotiated contracts against contract specifications.
• Identify gaps and address remediations to support process improvements.

Skills

Medical claims knowledge

Analytical problem solving

Time management

Organizational skills

Interpersonal skills

Team player

Education

Bachelor's degree or equivalent experience

Tools

FACETS

CLMS

MS Office Suite

Job description

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

The role emphasizes collaboration, problem solving, and continuous improvement, with a focus on accuracy, attention to detail, and strong claims knowledge to support operational excellence.