Configuration Analyst, Experienced

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 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.

Your Knowledge and Experience

• 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
• Certified auditor in auditing BSC provider contracts or claims audit preferred
• 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