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Claim Configuration Analyst Jobs in Georgia (NOW HIRING)

Conduent, Inc.

Business Analyst (MMIS)

Atlanta, GA · On-site +1

Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ... Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable ...

Conduent, Inc.

Business Analyst (MMIS)

Atlanta, GA · On-site +1

Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ... Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable ...

Conduent, Inc.

Senior Business Analyst (MMIS)

Atlanta, GA · On-site +1

$89K - $114K/yr

Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ... Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable ...

HealthOne Alliance

Payment Integrity Analyst

Dalton, GA · On-site

... claim data to validate coding accuracy and medical necessity. • Apply CPT, HCPCS, ICD-10-CM/PCS ... Configuration, Provider Relations, Compliance, Legal, Analytics, Medical Management) to resolve ...

Executive Recruiting Group

Quality Engineer

Valdosta, GA · On-site

$58K - $76K/yr

Ensures the final configuration bill of materials is provided to the warehouse to execute. Manages ... Manages customer and factory Claim process by: * Reviewing customer maintenance records ...

Executive Recruiting Group

Quality Engineer

Valdosta, GA · On-site

$58K - $76K/yr

Ensures the final configuration bill of materials is provided to the warehouse to execute. Manages ... Manages customer and factory Claim process by: * Reviewing customer maintenance records ...

Reserv, Inc.

Trucking Total Loss Adjuster

Atlanta, GA · On-site +1

You'll also be expected to analyze downtime and loss-of-use exposures and manage rental and ... claim and explain policy, coverage, and appropriate course of action * Manage an inventory of ...

QTS Realty Trust, Inc.

Solution Architect

Suwanee, GA · On-site

$58.75 - $77.25/hr

Implementation & Integration * Oversee the technical implementation, configuration, and ... Strong communication, collaboration, and analytical skills, with a proactive, can-do attitude.

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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 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.

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.

Is claims processing a stressful job?

Claims processing as a Claim Configuration Analyst can be stressful due to the need for accuracy, attention to detail, and meeting deadlines. The role often involves handling complex cases and using specialized software, which can contribute to work pressure. 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 Georgia? For Claim Configuration Analyst jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Claim Configuration Analyst jobs in Georgia look for? The top searched job categories for Claim Configuration Analyst jobs in Georgia are:
What cities in Georgia are hiring for Claim Configuration Analyst jobs? Cities in Georgia with the most Claim Configuration Analyst job openings:
Claim Configuration Analyst jobs near you

Business Analyst (MMIS)

Conduent, Inc.

Atlanta, GA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Conduent rating

6.0

Company rating: 6.0 out of 10

Based on 186 frontline employees who took The Breakroom Quiz

36th of 71 rated call and contact centers

Job description


Business Analyst - CMdS Claims, Member & Finance Implementation (MES)
Experience: 6+ years
Domain: Medicaid Enterprise Systems (MES) | MMIS modernization | Claims / Member / Finance
Role summary
Serve as Business Analyst for CMdS product development and implementation on a Medicaid modernization program. Translate legacy MMIS claims, member, and finance behavior and state Medicaid policy into CMdS functional design, requirements, and acceptance criteria. Partner with development, QA, architecture, and business stakeholders to deliver MES-aligned solutions that replace or integrate with legacy adjudication, eligibility/enrollment, and financial accounting processes.
Key responsibilities
Delivery & analysis
  • Own requirements and functional design for assigned CMdS modules (Claims, Member, Finance, and related interfaces).
  • Define epics, user stories, and definition of done; prioritize against Medicaid policy, MES certification goals, and release plans.
  • Facilitate working sessions; clarify requirements for developers and QA; resolve functional questions during build and test.
  • Track scope, dependencies, risks, and decisions; maintain traceability from legacy rule to CMdS design to test evidence.

Functional design (Claims, Member, Finance)
  • Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits, adjustment/void, crossover, encounters, remittance, and related edit disposition behavior; map legacy rules to CMdS configuration and customizations.
  • Member: Lead design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member.
  • Finance: Lead design for payment cycles, budget account / category of service, fund splits, ASO / F/EA and other administrative payment paths, financial transactions, and reporting/accounting controls.
  • Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable for build and UAT.

Collaboration with Development & QA
  • Work side-by-side with developers on design walkthroughs, edge cases, and defect triage.
  • Partner with QA to define test scenarios, expected results, and regression packs (positive/negative, adj/void, crossover, encounter, finance posting).
  • Support SIT, UAT, and parallel/run-compare activities against legacy MMIS outcomes.
  • Validate that implementations meet Medicaid policy and MES operational readiness (security, audit, reporting, interfaces).

Stakeholder & MES engagement
  • Run workshops with business owners, SMEs, fiscal, and operations.
  • Align designs to CMS MES expectations (modularity, interoperability, standards-based interfaces, certification evidence).
  • Support change management: training outlines, release notes, and operational runbooks for CMdS go-live.

Required qualifications
  • 6+ years business analysis experience in Medicaid MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial Accounting.
  • Proven experience developing and implementing claims systems / MMIS / MES platforms, such as Conduent CMdS (Conduent Medicaid Suite), Health Enterprise, QNXT, Facets, or comparable commercial Medicaid/claims suites.
  • Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a commercial Medicaid platform.
  • Strong Medicaid domain knowledge, including:
    • FFS vs managed care; capitation vs ASO / administrative services models
    • Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters
    • Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts
    • Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts
    • CMS / state Medicaid policy drivers relevant to MES implementation and certification
  • Demonstrated ability to write clear functional design and acceptance criteria for complex adjudication and financial rules.
  • Experience working embedded with development and QA teams in Agile or hybrid SDLC.
  • Excellent facilitation, documentation, and stakeholder communication skills.

Preferred qualifications
  • Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth).
  • Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows.
  • Experience supporting CMS MES certification artifacts and evidence packages.
  • Prior lead BA experience on multi-module MES releases.

Soft skills
  • Comfortable owning ambiguity when legacy rules are incomplete; drives decisions with SMEs.
  • Balances policy accuracy with delivery timelines.
  • Credible with technical teams and business executives alike.

Education
Bachelor's degree in business, Information Systems, Health Informatics, or related field (or equivalent experience).
Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $70,000 - $90,000.
About Us
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
About the Team
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
For US applicants: People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded: click here to access or download the form. Complete the form and then email it as an attachment to FTADAAA@conduent.com. You may also click here to access Conduent's ADAAA Accommodation Policy.

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About Conduent

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Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Industry

It services

Company size

10,000+ Employees

Headquarters location

Florham Park, NJ, US

Year founded

2017

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