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Claim Configuration Analyst Jobs in California (NOW HIRING)

Compunnel

NetworX Configuration Analyst

Hollister, CA · On-site

Direct comprehensive unit, regression, and end-to-end testing processes to ensure accurate claim ... Strong analytical, troubleshooting, and configuration management skills. * Ability to collaborate ...

LIBERTY DENTAL

System Configuration Analyst

Tustin, CA · On-site

Analyze and process complex claim and UM scenarios * Assist with benefit implementation and claims/UM system configuration * Coordinate with cross-functional teams to implement and maintain member ...

AArete

Senior Pharmacy Data Analyst

El Segundo, CA · On-site

$125K - $140K/yr

Support pharmacy plan, client, and contract configuration activities through analytic review, testing, and validation of claim outcomes * Validate data quality, completeness, and reasonableness of ...

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Claim Configuration Analyst information

What is a claim configuration analyst?

Claim Configuration Analysts are professionals who specialize in setting up and maintaining the rules, processes, and systems that handle insurance claims within an organization. They ensure that claim processing systems are configured accurately to follow policy guidelines, regulatory requirements, and company procedures. Their role often involves analyzing data, troubleshooting issues, and collaborating with IT, claims, and business teams to optimize claim workflows. By ensuring correct system configurations, they help reduce errors, improve operational efficiency, and support timely claim resolutions.

What are the key skills and qualifications needed to thrive as a claim configuration analyst, and why are they important?

To thrive as a Claim Configuration Analyst, you need a strong understanding of healthcare claims processing, benefits administration, and analytical problem-solving, often supported by a degree in business, information systems, or a related field. Familiarity with claims adjudication systems (such as Facets or QNXT), SQL, and potentially industry certifications like Certified Claims Professional (CCP) are commonly required. Attention to detail, effective communication, and the ability to work collaboratively with cross-functional teams are crucial soft skills. These competencies ensure accurate claim system configuration, regulatory compliance, and efficient operations within health insurance organizations.

What are some common challenges faced by claim configuration analysts, and how can they be addressed?

Claim Configuration Analysts often encounter challenges such as interpreting complex insurance policies, ensuring accurate system configuration to minimize claim errors, and keeping up with frequent regulatory changes. Addressing these challenges requires strong analytical skills, attention to detail, and effective collaboration with cross-functional teams like IT, compliance, and claims processing. Regular training and open communication channels help analysts stay updated and maintain high-quality configurations, ultimately reducing errors and improving efficiency.

What is the difference between Claim Configuration Analyst vs Claims Processor?

AspectClaim Configuration AnalystClaims Processor
Primary ResponsibilitiesDesigns and manages claim system setups, analyzes configuration issues, and optimizes claim workflows.Processes individual claims, verifies information, and ensures accurate claim adjudication.
Required Skills & CertificationsKnowledge of insurance systems, data analysis, and possibly certifications like CPCU or similar.Attention to detail, familiarity with claims software, and basic insurance knowledge.
Work EnvironmentTypically office-based, working with IT teams and claims systems.Office or remote, handling claims directly or via claims processing platforms.

The Claim Configuration Analyst focuses on configuring and optimizing claim systems and workflows, while the Claims Processor handles the day-to-day processing of individual claims. Both roles require insurance knowledge, but the analyst role emphasizes system setup and analysis, whereas the processor role emphasizes claim review and verification.

Is claims processing a stressful job?

Claims processing as a Claim Configuration Analyst can be stressful due to tight deadlines, high accuracy requirements, and the need to resolve complex issues efficiently. The role often involves detailed data analysis and communication with stakeholders, which can contribute to work-related stress. However, workload and stress levels vary depending on the organization and individual workload management skills.

What are popular job titles related to Claim Configuration Analyst jobs in California?

For Claim Configuration Analyst jobs in California, the most frequently searched job titles are:

What job categories do people searching Claim Configuration Analyst jobs in California look for?

The top searched job categories for Claim Configuration Analyst jobs in California are:

What cities in California are hiring for Claim Configuration Analyst jobs?

Cities in California with the most Claim Configuration Analyst job openings:

Claim Configuration Analyst jobs near you

NetworX Configuration Analyst

Compunnel

Hollister, CA • On-site

Contractor

Posted 6 days ago

Job description

Job Summary
The NetworX Configuration Analyst will be responsible for configuring, maintaining, and modeling complex pricing logic within the TriZetto Facets Integrated NetworX Pricer environment. The role requires strong hands-on experience with NetworX Pricer, translating managed care provider contracts into accurate system configurations, and ensuring claim payment accuracy through comprehensive testing and data validation. The position will also support configuration workflows, system conversion projects, pricing updates, and collaboration across configuration, claims operations, and legal contracting teams.
Key Responsibilities
  • Configure, maintain, and model complex pricing logic within the TriZetto Facets Integrated NetworX Pricer software system.
  • Translate managed care provider contract language into precise fee schedules, rate sheets, and system qualifiers.
  • Manage day-to-day NetworX configuration workflows and support configuration activities across platforms.
  • Mentor configuration analysts and provide technical guidance on NetworX configuration activities.
  • Coordinate system conversion projects across platforms.
  • Direct comprehensive unit, regression, and end-to-end testing processes to ensure accurate claim payment.
  • Utilize advanced Oracle SQL queries and relational databases to audit, validate, and troubleshoot large configuration data batches.
  • Establish hierarchical system logic to correctly prioritize specific provider agreements over standard or regional fallback rates.
  • Monitor and implement quarterly pricing component updates to maintain compliance with CMS, Medicare, and Medicaid requirements.
  • Act as the primary liaison between Configuration leadership, claims operations, and the legal contracting team.
  • Identify and troubleshoot configuration and pricing issues to support accurate claims processing.
  • Perform other duties as assigned.

Required Qualifications
  • 5-6 years of hands-on experience with NetworX Pricer.
  • Strong hands-on experience with NetworX Configuration, including Integrated NetworX.
  • Strong experience configuring and maintaining pricing logic within NetworX Pricer.
  • Strong experience translating provider contract language into system pricing configurations.
  • Advanced Oracle SQL skills for data validation, auditing, and troubleshooting.
  • Experience with relational databases and large configuration data sets.
  • Strong experience with unit, regression, and end-to-end testing of pricing configurations.
  • Experience with provider agreements, fee schedules, rate sheets, and system qualifiers.
  • Strong understanding of hierarchical pricing logic and provider-specific pricing rules.
  • Experience supporting CMS, Medicare, and Medicaid pricing updates.
  • Strong analytical, troubleshooting, and configuration management skills.
  • Ability to collaborate effectively with configuration, claims operations, and legal contracting teams.

Preferred Qualifications
  • Experience with TriZetto Facets.
  • Experience with Facets Integrated NetworX environments.
  • Experience mentoring configuration analysts.
  • Experience coordinating system conversion projects across platforms.
  • Experience working in healthcare claims and managed care environments.

Years of Experience
13+ years of overall experience.
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About Compunnel

Sourced by ZipRecruiter

Compunnel is a well-known company located in Plainsboro, NJ, US, recognized in the industry of IT Services and Solutions. Established in 1989, Compunnel offers a suite of services that help businesses integrate technology efficiently into their operations, a recognizable name in the IT solutions sphere for over three decades. The company’s service portfolio includes Digital Transformation, Business Intelligence, Cloud Services, Cybersecurity, and Application Modern Services, among others. Guided by its mission "to innovate with industry-leading digital solutions and disruptive tech strategies for unimagining business growth," the company underlines its commitment to offering out-of-the-box solutions to its clients. Remarkable achievements of the company include serving more than 30 Fortune 500 companies and providing job opportunities for over 50,000 individuals.

Industry

It services

Company size

501 - 1,000 Employees

Headquarters location

Plainsboro, NJ, US

Year founded

1994

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