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Claim Configuration Analyst Jobs in Indiana (NOW HIRING)

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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 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.
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Claim Configuration Analyst jobs near you
Business Analyst - Healthcare

Business Analyst - Healthcare

Gainwell Technologies LLC

Indianapolis, IN • On-site

$55K - $79K/yr

Other

Medical, Life, Retirement, PTO

Posted 27 days ago

Gainwell Technologies rating

7.7

Company rating: 7.7 out of 10

Based on 77 frontline employees who took The Breakroom Quiz

122nd of 209 rated software companies

Job description

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.
Summary
As a Business Analyst - Healthcare at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve - a community's most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges.
Works collaboratively with the client and team members-both external and internal to the company - to research, validate and document business needs, and to ensure that those needs are clearly reflected and completed. Assists with translating client requests and changes into the MMIS and may help determine solutions to business problems. Effectively manages client's expectations.
Here are the details on this position.
Your role in our mission
Gainwell empowers you show you're a pro and help clients deliver better health and human services outcomes using innovative technology and solutions.
  • Ensure that items are prepared for client meetings.
  • Ensure Operating Procedure Manuals are updated as required
  • Work with the client on change requests, publications and claim adjustments/reprocessing
  • Research, identify, and specify solutions to problems.
  • Document updates for all reference updates/changes.
  • Work with the systems team on any assigned system changes, meeting required timelines
  • Assist with quarterly and annual CPT, HCPCS and diagnosis code updates in the system, ensuring rules are correct and working on edit and audit configuration.

What we're looking for
  • 3+ years as a Business Analyst with healthcare claims experience required.
  • A Certified coder is preferred
  • Proficiency in CPT, HCPCS, and ICD-10 coding
  • Ability to work collaboratively in a team environment, including making updates to reference systems for coding (CPT, HCPCS, ICD-10) and benefit plan coverage
  • Strong Excel skills
  • Excellent verbal and written communication skills with the ability to build strong working relationships
  • Ability to create and maintain manual documentation and support provider notifications

What you should expect in this role
  • Fully remote options from continental US locations only
  • Video cameras must be used during all interviews, as well as during the initial week of orientation
  • The deadline to submit applications for this posting has been extended until a suitable candidate is selected

#LI-HC1
#LI-Healthcare Claims
#LI-Certified Coder
The pay range for this position is $55,600.00 - $79,400.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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Hours and flexibility

Workplace

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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