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 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
• 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
• Other duties as assigned

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

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.