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JOB DESCRIPTION
Your Role

The Pricing Analytics and Contract Configuration team is responsible for configuring systems to pay per negotiated provider contracts. The Configuration Analyst, Associate will report to the Pricing Analytics Contract Configuration Manager. In this role you will conduct build activity, run test claims to ensure future claims will be paying correctly based on the contractual terms, 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
• Work directly with Provider Contracting partners for clarifications when contract language may be unclear.
• Analyze the provider contracts to ensure accuracy in the way it was built
• 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

QUALIFICATIONS
Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• 0-2 years of prior relevant experience
• Requires strong Claim’s 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
  

Pay Range:

The pay range for this role is: $ 25.56 to $ 35.78 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.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.