Provider Contract Configuration Analyst

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

Job summary

Blue Shield of California is seeking a QC Pricing Analytics and Contract Configuration Analyst Associate to perform in-line audits of negotiated provider contacts and run test claims to ensure correct future payments according to contract terms.

The role emphasizes strong medical claims knowledge, auditing experience, and collaboration within a hybrid work model. This position supports improvements by identifying gaps and remediation opportunities.

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 philosophy with strong analytical, 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.
• Conduct audits and run test claims to ensure future claims are paid correctly per contract terms.
• Validate that negotiated provider contracts are built correctly according to specifications.
• Support process improvements by identifying gaps and addressing remediations.

Skills

Medical claims knowledge

Analytical skills

Problem solving

Time management

Organizational skills

Interpersonal skills

Team player

Education

Bachelor's degree or equivalent

Tools

FACETS

CLMS

MS Office Suite

Job description

Blue Shield of California is seeking a QC Pricing Analytics and Contract Configuration Analyst Associate to perform in-line audits of negotiated provider contacts and run test claims to ensure correct future payments according to contract terms.

The role emphasizes strong medical claims knowledge, auditing experience, and collaboration within a hybrid work model. This position supports improvements by identifying gaps and remediation opportunities.