Healthcare Provider Network & Contract Management Specialist

Healthcare Provider Network & Contract Management Specialist

Cobalt Benefits Group LLC BOSTON, Massachusetts, United States

The Healthcare Provider Network & Contract Management Specialist is responsible for maintaining, updating, and ensuring the integrity of healthcare provider and contract-related data within the health plan administration system. This role supports provider network management, client-specific healthcare contract implementation, reimbursement validation, pricing configuration, network tiering, and contract testing activities.

The ideal candidate is detail-oriented, analytical, and collaborative, with the ability to work effectively across operational teams, clients, and external partners to ensure accurate implementation and maintenance of provider network and contract configurations.

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.

Requirements

• 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.

Benefits

• Fantastic medical, dental, and vision insurance*
• Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
• Company provided Basic Life and AD&DD
• Company paid Short-Term and Long-Term Disability**
• Flexible Spending Accounts*
• 401(k) Retirement Plan with up to a 6% employer-match
  ** WOW! (100% fully vested after 3 years)
• 10+ paid holidays
• Fully Paid half day Summer Fridays
• Generous paid vacation and sick time
• Annual Paid Volunteer Day
• Annual Tuition Reimbursement
• Annual Health and Wellness Reimbursement
• Lots of fun company events

* 60 day waiting period
** 90 day waiting period

Who We Are

Cobalt Benefits Group has been named one of the Best Companies to Work for in NH 2026 by NH Business Magazine! As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four lines of business: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue, and Great Bay Administrators.

With over 30 years of experience and a dedicated team of more than 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized…