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Claim Configuration Analyst Jobs in Michigan (NOW HIRING)

CVS Health

MI · On-site

$18.50 - $38.82/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... claim processing, and billing purposes. The role operates in a high-volume production environment ... Ability to analyze processes and recommend workflow improvements that enhance efficiency and ...

All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Michigan

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.
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Claim Configuration Analyst jobs near you

Discovery Business and System Analyst (Top Secret Clearance Required)

Contact Government Services, LLC

Detroit, MI

$92K - $125K/yr

Full-time

Re-posted 9 days ago

Job description

Discovery Business and System Analyst
Employment Type: Full-Time, Executive-Level
Department: Legal   
 
CGS is seeking a dedicated Discovery Business and System Analyst to join a fast-paced and hard-working team to assist with any legal accounts. As a Discovery Business and System Analyst, you will play a key role in supporting various aspects of the company's portfolio. 
 
CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.
 
Skills and attributes for success:
The Contractor shall provide business and IT systems analysis support to include, but not limited to the following activities: 
-         Contractor shall document and manage new and existing business processes in order to facilitate training, analysis, and redesign; 
-         Contractor shall conduct a thorough analysis of existing and new business processes and identify opportunities for improving workforce efficiency; 
-         Contractor shall conduct a thorough analysis of operational business requirements and conduct a gap analysis for any required modification to an existing business process; 
-         Contractor shall create and maintain a requirements database that documents how each existing or new business requirement is being supported 
-         Contractor shall validate that any proposed solution to an existing requirement satisfactorily meets the underlying need; 
-         Contractor shall collect marketing materials from industry solution providers that claim to satisfy the identified business requirements; 
-         Contractor shall document and manage new and existing functional capabilities provided by existing and proposed IT solutions; 
-         Contractor shall conduct a thorough analysis of existing capabilities against documented business requirements to determine where gaps in technology are impeding or preventing the efficient execution of business processes; 
-         Contractor shall compare marketing materials from industry solution providers that claim to satisfy the identified business requirements and deliver an Analysis of Alternatives that can be used by the Program Management Office (PMO) to identify and prioritize new projects; 
-         Contractor shall validate that any proposed solution successfully delivers a new functional business capability that addresses one or more existing requirements; 
-         Contractor shall build and execute thorough test scripts that allow them to ascertain the breadth and depth of a capability on a consistent basis so that they may fairly evaluate multiple products in order to provide recommendations for purchase; 
-         Contractor shall review all solution configuration changes to insure that the Discovery Program maintains an accurate picture of its business capabilities; 
-         Contractor shall perform other systems analysis research and documentation tasks as assigned.  
 
 
Our Commitment:
Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems.
 
For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work.
Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come.
 
We care about our employees. Therefore, we offer a comprehensive benefits package.
-         Health, Dental, and Vision
-         Life Insurance
-         401k
-         Flexible Spending Account (Health, Dependent Care, and Commuter)
-         Paid Time Off and Observance of State/Federal Holidays
 
Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
 
Join our team and become part of government innovation!
Explore additional job opportunities with CGS on our Job Board:
https://cgsfederal.com/join-our-team/
For more information about CGS please visit: https://www.cgsfederal.com or contact:
Phone: +1 (888) 680-5916Email: info@cgsfederal.com
 
 
#CJ
 

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.