Your Role

The QC Pricing Analytics and Contract Configuration team is responsible for performing an in-line audit for all negotiated provider contacts. The QC Configuration Analyst, Experienced will report to the QC Pricing Analytics Contract Configuration Manager. In this role, you will conduct audits and run test claims to ensure future claims will be paid correctly based on the contractual terms. You will validate that the negotiated provider contracts were built correctly and according to the contract's specification and support process improvements by identifying possible gaps and addressing remediations.

Your Work

In this role, you will:

• Analyze contract language to translate into specific pricing configuration with guidance
• Develop simple configuration approaches to support solution selection and develop documentation outlining the approach using appropriate documentation protocols
• Be accountable for the at least one contract type of configuration and testing of the assigned contracts
• Develop and execute claims tests to support the testing terms and services for in the negotiated contracts
• Provide configuration feedback through the audit process
• Analyze the provider contracts to ensure accuracy in the way it was built
• Identify and document audit observations and findings
• Service (internal customers) with an oriented/philosophy and work in a diverse, demanding and evolving environment where strong analytical, problem-solving skills, time management and organizational skills are required
• Perform other duties as assigned

Your Knowledge and Experience

• Requires a bachelor's degree in Health Care Management, Computer Science, or a related discipline (or an equivalent combination of education and work experience may be taken into consideration in lieu of a degree)
• Requires at least 1 year of experience in a configuration analyst role, configuring health plan business applications
• Requires at least 3 years performing complex business analysis and/or technology healthcare operations
• Requires to be a certified auditor in auditing BSC provider contracts or claims audit
• Requires strong medical claims knowledge and experience
• Knowledge of FACETS, CLMS, NetworX, Office Suite
• Works independently on moderately complex projects/assignments
• Problems are typically solved through drawing from prior experiences, with analysis of the issue
• Provide guidance and assistance to entry level professionals and/or support employees
• Service (internal customers) oriented/Philosophy in a diverse, demanding, and evolving environment with excellent analytical and problem-solving skills, time management and organizational skills
• Excellent interpersonal skills and ability to act as a team player

Pay Range:

The pay range for this role is: $ 66770.00 to $ 93390.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.