The Provider Network & Contract Management Specialist is responsible for maintaining, updating, and ensuring the integrity of provider and contract-related data within the health plan administration system. This role supports provider network management, client-specific healthcare contract implementation, reimbursement validation, pricing configuration, network tiering, and contract testing activities.

The ideal candidate is detail-oriented, analytical, and collaborative, with the ability to work effectively across operational teams, clients, and external partners to ensure accurate implementation and maintenance of provider network and contract configurations.

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.

• Associate degree or equivalent combination of education and experience.
• Three or more years of related experience preferred.
• Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word.
• 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.
• 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.

Benefits

After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:

• Fantastic medical, dental, and vision insurance*
• 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**
• Flexible Spending Accounts*
• 401(k) Retirement Plan with up to a 6% employer-match** WOW! (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

*60 day waiting period**90 day waiting period

Who We Are

As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four lines of business: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue,and Great Bay Administrators. With over 30 years of experience and a dedicated team of more than 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit https://www.cobaltbenefitsgroup.com/careers/.

Cobalt Benefits Group is an Equal Employment Opportunity employer.

Cobalt Benefits Group participates in E-Verify to confirm the employment eligibility of all new hires.