💼 Employment Type: Full-Time
📍 Location: Remote (U.S.)
💬 Job Overview
EmblemHealth is seeking a detail-driven Contract Specialist to support the accurate loading, configuration, and maintenance of Professional, Facility, and Ancillary contracts across all lines of business. In this remote role, you’ll serve as a subject-matter expert in contract configuration, fee schedules, rate structures, and reimbursement methodologies. You’ll work closely with Network Development, Analytics, and system operations teams to ensure contracts are translated correctly into core platforms and that downstream reimbursement aligns with negotiated intent. If you’re strong in analysis, coding structures, and healthcare reimbursement — and want a technical remote role rooted in precision — this is an excellent fit.
📋 Key Responsibilities
Participate in all aspects of configuring provider, facility, and ancillary rate structures within Network systems while meeting deadlines.
Collaborate with Network Management and Analytics teams to verify accurate capture and modeling of negotiated contracts.
Analyze contract terms to determine correct interaction with core systems and ensure reimbursement logic is aligned with intent.
Identify, troubleshoot, and resolve rate load discrepancies.
Assist with fee schedule, grouper logic, and rate reimbursement setup and maintenance.
Update evergreen contracts and maintain accurate configuration documentation.
Recommend contract language improvements to enhance system compatibility.
Coordinate rate testing with Business Technology Services (BTS) for quality assurance.
🧩 Preferred Qualifications
Bachelor’s degree in Business Operations, Information Systems, or related field (required).
Master’s degree a plus, but not required.
2–3 years of healthcare-related experience involving contract setup, modeling, or reimbursement analysis (required).
Strong familiarity with EmblemHealth claims systems and related applications (required).
Experience configuring provider, facility, and ancillary contract files — including testing and auditing.
Clear understanding of medical terminology, ICD/CPT/HCPCS codes, and fee schedule structures.
Knowledge of government reimbursement methodologies (Medicare/Medicaid).
Analytical mindset with excellent problem-solving, organizational, and technical skills.
High attention to detail and accuracy in fast-paced environments.
Hiring Range: $48,600–$83,160
✨ Why You’ll Love This Job
This role blends analytical work, healthcare operations, and contract interpretation — all within a respected, mission-driven health organization. You’ll work fully remote, collaborate across business and technical teams, and take ownership of contract accuracy that directly impacts reimbursement integrity. If you enjoy system-level thinking, data accuracy, and process improvement, this position offers long-term stability and professional growth.
🌟 Who This Job Is Perfect For
Analytical thinkers who love organizational structure and precise detail.
Healthcare operations professionals with reimbursement, coding, or claim-system experience.
Candidates who enjoy translating complex contract language into system logic.
Individuals who thrive in collaborative, cross-functional technical roles.
People who prefer structured workflows over customer-facing responsibilities.
🏢 About the Company
EmblemHealth is one of the nation’s largest nonprofit health insurers, serving individuals, families, and employers for over 80 years. Headquartered in New York, the organization is committed to delivering high-quality, affordable care through innovation, community health programs, and strong provider partnerships. Their teams work collaboratively to improve healthcare experience and support members across diverse communities.
🚀 How to Apply
You’ll be redirected to EmblemHealth’s official careers page to submit your application.
