Perform data quality assessments and reconcile claim, membership, and financial data across ... Provide detailed configuration expertise to customers and business partners. This includes verbal ...
Perform data quality assessments and reconcile claim, membership, and financial data across ... Provide detailed configuration expertise to customers and business partners. This includes verbal ...
Clean claim rate * Denial rate and overturn rate * Point-of-service collections Epic Analytics ... Ensure proper configuration of WQs (workqueues), edits, and rules to support efficient workflows ...
Clean claim rate * Denial rate and overturn rate * Point-of-service collections Epic Analytics ... Ensure proper configuration of WQs (workqueues), edits, and rules to support efficient workflows ...
Clean claim rate * Denial rate and overturn rate * Point-of-service collections Epic Analytics ... Ensure proper configuration of WQs (workqueues), edits, and rules to support efficient workflows ...
Clean claim rate * Denial rate and overturn rate * Point-of-service collections Epic Analytics ... Ensure proper configuration of WQs (workqueues), edits, and rules to support efficient workflows ...
Clean claim rate * Denial rate and overturn rate * Point-of-service collections Epic Analytics ... Ensure proper configuration of WQs (workqueues), edits, and rules to support efficient workflows ...
Clean claim rate * Denial rate and overturn rate * Point-of-service collections Epic Analytics ... Ensure proper configuration of WQs (workqueues), edits, and rules to support efficient workflows ...
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 ...
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 ...
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?
| Aspect | Claim Configuration Analyst | Claims Processor |
|---|---|---|
| Primary Responsibilities | Designs and manages claim system setups, analyzes configuration issues, and optimizes claim workflows. | Processes individual claims, verifies information, and ensures accurate claim adjudication. |
| Required Skills & Certifications | Knowledge of insurance systems, data analysis, and possibly certifications like CPCU or similar. | Attention to detail, familiarity with claims software, and basic insurance knowledge. |
| Work Environment | Typically 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 often use specialized software or tools to optimize claim workflows. Strong attention to detail and knowledge of insurance or healthcare systems are essential for this role.
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 determine their validity and appropriate payout. They analyze claim details, ensure compliance with policies, and use data management tools to identify discrepancies or fraud, supporting accurate and efficient claims resolution.
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 leadership or highly specialized fields.
Is SOC an entry level job?
A SOC (Security Operations Center) analyst role is typically considered an entry to mid-level position, depending on the organization. Entry-level SOC analysts usually require basic knowledge of cybersecurity concepts, monitoring tools, and incident response, with opportunities for certification such as CompTIA Security+ to advance. Experience requirements vary, but many organizations offer training for new analysts.
What are popular job titles related to Claim Configuration Analyst jobs in Indiana? For Claim Configuration Analyst jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Claim Configuration Analyst jobs in Indiana look for? The top searched job categories for Claim Configuration Analyst jobs in Indiana are:
What cities in Indiana are hiring for Claim Configuration Analyst jobs? Cities in Indiana with the most Claim Configuration Analyst job openings:
Principal Actuarial Data Systems Analyst
Indianapolis, IN • On-site
Other
Medical, Dental, Vision, Retirement, PTO
Re-posted 27 days ago
Blue Cross and Blue Shield of North Carolina rating
7.8
Based on 13 frontline employees who took The Breakroom Quiz
188th of 301 rated insurance
Job description
Job Description
Join a team where technology meets strategy. As a Principal Actuarial Data Systems Analyst, you will play a crucial role in delivering technical data support and innovative solutions for Actuarial financial data systems and Marts. You'll partner closely with actuaries, finance, medical economics, and data teams to analyze claims experience, medical cost trends, utilization patterns, IBNR reserving inputs, and predictive models that support business and actuarial decision-making. You will lead and coordinate development work to deliver solutions to support business areas/functions for implementation of accurate financial data.What You'll Do
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Develop complex decision support data solutions, data extracts, reports, data marts, and/or analysis. Responsible for the entire development life cycle.
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You'll partner closely with actuarial reserving teams to develop insights across the entire claims' lifecycle, from service occurrence and claim submission through adjudication, payment, runout, and reserve development.
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Develop and maintain datasets supporting IBNR reserve calculations, completion factors, lag analyses, and actuarial modeling.
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Partner with healthcare actuarial reserving teams to support monthly and quarterly reserve analyses, financial forecasts, and experience studies
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Perform data quality assessments and reconcile claim, membership, and financial data across multiple systems.
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Analyze medical and pharmacy claims data to identify utilization trends, cost drivers, emerging risks, and opportunities for operational improvement.
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Performs monthly data refreshes, validations, automations, and quality assurance checks to support executive financial reporting.
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Manages the Maintenance and optimization of the Actuarial Systems Data Marts.
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Serve as the lead for multiple application areas, including data definitions, usage and file structure, technical structure of the code and the business rules, and structure of requirements that govern the functionality of the system.
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Independently analyze business challenges or opportunities; develop recommendations and solutions, implement those solutions, and provide communications on the associated actions, business impacts, and results.
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Lead in ensuring Financial granular detail data is appropriately auditable, snapshotted, and stored for quarterly and year end audits.
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Provide analytical support for departmental, divisional, and corporate projects as needed to accomplish their business goals and to ensure the business needs are met.
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Coordinate work and provide direction, assistance and training to peers and junior staff members.
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Provide detailed configuration expertise to customers and business partners. This includes verbal, written, and electronic communication, and delivering presentations when needed.
What You Bring
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Bachelor's degree or advanced degree (where required)
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8+ years of experience in related field.
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In lieu of degree, 10+ years of experience in related field.
Bonus Points
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5+ years of SQL Development/Analysis experience. (Highly preferred)
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5+ years of healthcare analytics, actuarial analytics, payer analytics, or strong medical claims data functional/life cycle knowledge (Highly preferred).
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Facets experience a plus.
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Experience supporting actuarial trend analysis.
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Experience with Snowflake, AWS cloud environments.
What You'll Get
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The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.
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Work-life balance, flexibility, and the autonomy to do great work.
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Medical, dental, and vision coverage along with numerous health and wellness programs.
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Parental leave and support plus adoption and surrogacy assistance.
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Career development programs and tuition reimbursement for continued education.
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401k match including an annual company contribution
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Learn more
WhereYou'llWork
Our Hybrid Flex approach is builton presencewith a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplacethat'sflexible, connected, and future focused.
In a Hybrid-Flex role,you'llwork in the office at least two days a week for collaboration and connection. In a Remote Flex role,you'llwork virtually, with a few in-office visits each year formeaningfulmoments that matter.
Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in anystateslistedonthis job posting. Onsite expectations will be discussed during the interview process.
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
Application Implementation, Best Practices Development, Business Process Improvements, Business Requirements, Business Requirements Analysis, Information Technology (IT) Projects, Information Technology Project Management, Requirements Gathering, Requirements Management, Technical Architecture_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
What Blue Cross and Blue Shield of North Carolina employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Blue Cross and Blue Shield of North Carolina
Sourced by ZipRecruiter
Industry
Insurance services
Company size
5,001 - 10,000 Employees
Headquarters location
Durham, NC, US
Year founded
1933