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Claim Configuration Analyst Jobs in Indiana (NOW HIRING)

BDA

Industrial Engineer (WMS/ERP)

Plainfield, IN · On-site

$68K - $92K/yr

Most companies claim to have the best people. We say to them, "Keep dreaming." Our people are ... Strong financial and analytical ability, including experience with forecasting, budgeting, variance ...

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Claim Configuration Analyst information

What are Claim Configuration Analysts?

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 does a configuration analyst do?

A claim configuration analyst is responsible for setting up and maintaining claim processing systems, ensuring accurate claim adjudication and compliance with policies. They analyze system configurations, troubleshoot issues, and may use tools like claim management software to optimize workflows and reduce errors.

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 does a claims analyst do?

A claims analyst reviews and processes insurance claims to ensure accuracy and compliance with policies. They investigate claim details, verify documentation, and determine claim validity, often using specialized software and data analysis skills. Their work helps ensure timely and fair claim settlements for clients and insurers.

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 jobs pay 500,000 a year in the US?

Claim Configuration Analysts typically do not earn $500,000 annually; such high salaries are usually associated with executive roles, specialized surgeons, or successful entrepreneurs. High-paying jobs often require advanced skills, extensive experience, or ownership of a business. Compensation at this level is rare in standard analyst positions and more common in executive or highly specialized fields.

What jobs pay 2000 a day?

Claim Configuration Analysts typically do not earn $2000 a day; such high daily rates are more common in specialized consulting, executive roles, or highly paid freelance positions. Most standard roles in claims analysis offer annual salaries rather than daily rates, but freelance or contract work in related fields can sometimes reach that level with extensive experience and expertise. Earning $2000 a day generally requires advanced skills, certifications, or senior-level responsibilities in high-demand industries.
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Claim Configuration Analyst jobs near you

Claims Lead

Local Indianapolis organization

Indianapolis, IN • On-site

$60K - $63K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 28 days ago

Job description

As a Claims Medical Processor, a qualified candidate will work within our growing Health Benefit Fund team supporting our wide array of union members. Member services standard hours are between 8 - 5 pm. This is an in-house, onsite position.

Responsibilities:

  • Accurately process claims by researching benefits, claim policies, procedure and reviewing claim edits.
  • Answer incoming telephone calls to assist customers with explanations and issue resolution of healthcare policies, benefits, eligibility and coverage.
  • Understand and update claim system configuration.
  • Process claim adjustments, voids, and refunds.
  • Maintain claim resources, reference materials and training tools.
  • Manage daily workloads to ensure production goals are met and calls are resolved timely.
  • Verify accurate data entry, to include correct patient, coding, dollar amounts and provider information.
  • Maintain accuracy levels of 98% or higher for both payment and statistical data.
  • Work in assigned work groups/queues and assist in other areas as needed.
  • Work closely with senior staff, maintaining daily communication/updates.
  • Ability to train and coach others.
  • Ability to handle more complex cases and serve as a subject matter expert.
  • Perform other duties as assigned.

Required Qualifications:

  • High School Diploma or equivalent.
  • Knowledge of medical/insurance terminology.
  • Extensive knowledge of ICD-10, CPT, and CDT.
  • Excellent customer service – member first mentality
  • Research skills and ability to evaluate claims in order to resolve accurately.
  • Ability to interpret health plan contracts and benefit language.
  • Excellent oral and written communication skills that are shown in a respectful, pleasant and professional manner.
  • Work habits that include punctuality, ability to be a team player, willing to assist and support peers, as well as work independently with minimal direction.
  • Excellent negotiation, analytical, and problem solving skills.
  • Ability to prioritize workloads and perform under time pressures.

Preferred Qualifications:

  • Five years’ experience as claims processor
  • Ability to determine and process Coordination of Benefits, claims adjustments, and stop loss coverages.
  • Experience performing claim audits.
  • Experience taking inbound calls.