Configuration Analyst, Associate

Job Title

QC Configuration Analyst Associate

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 Associate 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. Validate that the negotiated provider contracts were built correctly and according to the contract's specification.

Support process improvements by identifying possible gaps and addressing remediations.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

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
• Other duties as assigned

Your Knowledge and Experience

• 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 (internal customers) oriented/philosophy in a diverse, demanding, and evolving environment with good analytical and problem-solving skills, time management, and organizational skills
• Excellent interpersonal skills and ability to act as a team player

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan;
Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair
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