Blue Shield of California · 9 hours ago
Configuration Analyst, Experienced
California, United States
Full-time
Hybrid
Mid Level
3+ years expBlue Shield of California is a nonprofit company focused on transforming healthcare to enhance affordability and quality. The QC Experienced Configuration Analyst will conduct audits and ensure claims are processed correctly based on contractual terms, while also supporting process improvements.
Financial ServicesHealth InsuranceNon Profit
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
Qualification
Required
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
Preferred
Certified auditor in auditing BSC provider contracts or claims audit preferred
Knowledge of FACETS, CLMS, NetworX, Office Suite
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
H1B Sponsorship
Blue Shield of California has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (1)
2022 (41)
2021 (20)
2020 (31)
Funding
Current Stage
Late StageLeadership Team
Gary Culp
Senior Vice President, Government Markets
Gregory Siebert
Senior Vice President Provider Partnerships & Network Management
Recent News
2026-01-13
Fierce Healthcare
2025-12-15
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