Strategic Healthcare Provider Network & Contract Specialist

Cobalt Benefits Group LLC; Boston (MA); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

HSA contributions

Life Insurance

Disability Insurance

FSA

401(k) with match

Paid holidays

Summer Fridays

Vacation & Sick Time

Volunteer Day

Tuition Reimbursement

Job summary

Cobalt Benefits Group LLC in Boston, MA is seeking a Healthcare Provider Network & Contract Management Specialist to maintain provider data and contract configurations within our health plan administration system. You will implement client-specific provider contracts and reimbursement methodologies, validate configurations, and coordinate testing to ensure accurate pricing and claims processing.

The role requires attention to detail, cross-functional collaboration, and the ability to work with

Qualifications

• Associate degree or equivalent combination of education and experience.
• Three or more years of related experience preferred.
• Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word.
• Experience with provider contracts, provider network maintenance, reimbursement validation, contract configuration, or healthcare network tiering preferred.
• Experience working with 835 and 837 electronic claim files preferred.
• Strong customer service skills with a commitment to supporting internal and external stakeholders.
• Excellent organizational, analytical, and problem-solving skills.
• Ability to prioritize work, manage multiple assignments, and work independently in a fast-paced environment.
• Strong written and verbal communication skills.

Responsibilities

• Implement, configure, and maintain client-specific provider contracts, reimbursement methodologies, pricing arrangements, and related system records.
• Validate contract configuration against approved client requirements, source documentation, fee schedules, and reimbursement methodologies.
• Develop, document, and execute contract testing scenarios to ensure accurate pricing, reimbursement, and claims processing outcomes prior to implementation or production updates.
• Coordinate contract implementation and maintenance activities with internal departments, network partners, clients, and other stakeholders.
• Maintain organized and accurate documentation related to provider networks, contracts, pricing arrangements, affiliations, tiering structures, and implementation decisions.
• Support provider network tiering setup, validation, testing, and ongoing maintenance activities.
• Monitor medical and dental network changes to ensure updates are implemented accurately, consistently, and in a timely manner.
• Perform provider contract and pricing maintenance, including the identification and resolution of configuration discrepancies.
• Import and analyze 835 and 837 electronic claim files to support contract validation, reimbursement analysis, and provider maintenance activities.
• Respond to provider, network, and contract-related requests within established service standards.
• Support audits, quality reviews, issue resolution, and continuous improvement initiatives related to provider data, contract configuration, network maintenance, and reimbursement accuracy.

Skills

Customer service

Analytical skills

Problem solving

Written communication

Verbal communication

Attention to detail

Collaboration

Education

Associate degree or equivalent

Tools

Microsoft Office (Outlook, Excel, Word)

835/837 claim files experience

Job description

Cobalt Benefits Group LLC in Boston, MA is seeking a Healthcare Provider Network & Contract Management Specialist to maintain provider data and contract configurations within our health plan administration system. You will implement client-specific provider contracts and reimbursement methodologies, validate configurations, and coordinate testing to ensure accurate pricing and claims processing.

The role requires attention to detail, cross-functional collaboration, and the ability to work with