Configuration Analyst, Experienced

Blue Shield of California•Rancho Cordova, CA

About The Position

The QC Pricing Analytics and Contract Configuration team is responsible for performing an in-line audit for all negotiated provider contacts. The QC Experienced Configuration Analyst 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. Responsibilities Your Work In this role, you will: Analyze medium to hard customers’ business requirements and software/product objectives and perform system configuration analysis, design, coding, and unit testing following established processes, standards and procedures Develop prototype configuration to support solution selection and develop documented solutions and processes using appropriate documentation protocols Resolve escalated issues in the appropriate manner and appropriate timeframe, to meet client specific SLAs Identify gaps between external expectations and system limitations and suggest configuration improvements or streamlined maintenance processes and techniques Act as the liaison between IT and business areas in support of extensions and service packs 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

Requirements

Requires a bachelor’s degree in healthcare 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 medical claims knowledge and provider contracts
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

Nice To Haves

Certified auditor in auditing BSC provider contracts or claims audit preferred
Knowledge of FACETS, CLMS, NetworX, Office Suite

Responsibilities

Analyze medium to hard customers’ business requirements and software/product objectives and perform system configuration analysis, design, coding, and unit testing following established processes, standards and procedures
Develop prototype configuration to support solution selection and develop documented solutions and processes using appropriate documentation protocols
Resolve escalated issues in the appropriate manner and appropriate timeframe, to meet client specific SLAs
Identify gaps between external expectations and system limitations and suggest configuration improvements or streamlined maintenance processes and techniques
Act as the liaison between IT and business areas in support of extensions and service packs
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