Provider Network & Contract Management Specialist

Summary

Cobalt Benefits Group is a third-party administrator specializing in self-funded benefit plans. The Provider Network & Contract Management Specialist maintains provider and contract data, configures healthcare contracts and reimbursement arrangements, validates pricing, and supports network tiering and contract testing. The role also coordinates implementation activities, analyzes electronic claim files, and resolves provider, network, and contract-related issues.

Responsibilities

• Implement, configure, and maintain client-specific provider contracts, reimbursement methodologies, pricing arrangements, and related system records
• Validate contract configuration against approved client requirements, source documentation, fee schedules, and reimbursement methodologies
• Develop, document, and execute contract testing scenarios to ensure accurate pricing, reimbursement, and claims processing outcomes prior to implementation or production updates
• Coordinate contract implementation and maintenance activities with internal departments, network partners, clients, and other stakeholders
• Maintain organized and accurate documentation related to provider networks, contracts, pricing arrangements, affiliations, tiering structures, and implementation decisions
• Support provider network tiering setup, validation, testing, and ongoing maintenance activities
• Monitor medical and dental network changes to ensure updates are implemented accurately, consistently, and in a timely manner
• Perform provider contract and pricing maintenance, including the identification and resolution of configuration discrepancies
• Import and analyze 835 and 837 electronic claim files to support contract validation, reimbursement analysis, and provider maintenance activities
• Respond to provider, network, and contract-related requests within established service standards
• Support audits, quality reviews, issue resolution, and continuous improvement initiatives related to provider data, contract configuration, network maintenance, and reimbursement accuracy

Skills

• Associate degree or equivalent combination of education and experience
• Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word
• Strong customer service skills with a commitment to supporting internal and external stakeholders
• Excellent organizational, analytical, and problem-solving skills
• Ability to prioritize work, manage multiple assignments, and work independently in a fast-paced environment
• Strong written and verbal communication skills
• Three or more years of related experience preferred
• Experience with provider contracts, provider network maintenance, reimbursement validation, contract configuration, or healthcare network tiering preferred
• Experience working with 835 and 837 electronic claim files preferred

Qualifications

Must Haves

• Associate degree or equivalent combination of education and experience
• Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word
• Strong customer service skills with a commitment to supporting internal and external stakeholders
• Excellent organizational, analytical, and problem-solving skills
• Ability to prioritize work, manage multiple assignments, and work independently in a fast-paced environment
• Strong written and verbal communication skills

Nice to Haves

• Three or more years of related experience preferred
• Experience with provider contracts, provider network maintenance, reimbursement validation, contract configuration, or healthcare network tiering preferred
• Experience working with 835 and 837 electronic claim files preferred

Benefits

• After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package.
• Fantastic medical, dental, and vision insurance (60 day waiting period)
• Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
• Company provided Basic Life and AD&D
• Company paid Short-Term and Long-Term Disability (90 day waiting period)
• Flexible Spending Accounts (60 day waiting period)
• 401(k) Retirement Plan with up to a 6% employer-match (90 day waiting period), 100% fully vested after 3 years
• 10+ paid holidays
• Fully Paid half day Summer Fridays
• Generous paid vacation and sick time
• Annual Paid Volunteer Day
• Annual Tuition Reimbursement
• Annual Health and Wellness Reimbursement
• Lots of fun company events