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Claim Configuration Analyst Jobs in Michigan (NOW HIRING)

Epitec

Systems Analyst II

Detroit, MI · On-site

$43 - $46/hr

Conduct root cause analysis and resolution of benefit configuration and claims processing defects ... Investigate claim processing issues and provide recommendations for corrective actions. * Support ...

All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Michigan

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.
What are popular job titles related to Claim Configuration Analyst jobs in Michigan? For Claim Configuration Analyst jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Claim Configuration Analyst jobs in Michigan look for? The top searched job categories for Claim Configuration Analyst jobs in Michigan are:
What cities in Michigan are hiring for Claim Configuration Analyst jobs? Cities in Michigan with the most Claim Configuration Analyst job openings:
Claim Configuration Analyst jobs near you

Systems Analyst II

Epitec

Detroit, MI • On-site

$43 - $46/hr

Contractor

This job post has expired today. Applications are no longer accepted.

Job description

  • Location: Detroit, Michigan
  • Type: Contract
  • Job #105393

Job Title: Systems Analyst II
Location:
Detroit, MI (Hybrid - 1-2 Days Onsite Per Week)
No Relocation, Only Accepting Local Candidates
Schedule:
Monday-Friday, Full-Time (40 Hours/Week)
Type:
W2 Contract Only, No C2C
Duration:
08/10/2026 - 02/12/2027 (Open-Ended)
Pay Rate:
$43.00 - $46.00/hour
Work Authorization:
Must be authorized to work in the United States.
Summary
We are seeking an experienced Systems Analyst II with strong healthcare benefits and claims processing expertise to support benefit configuration, coding, implementation, and defect resolution activities. This role will focus on NASCO benefit file coding, group benefit change implementations, healthcare reform initiatives, and claims-related analysis. The ideal candidate will possess a strong background in healthcare benefits systems, medical claims processing, and system analysis while collaborating closely with business and technical teams to ensure accurate benefit configuration and claims adjudication.
Key Responsibilities
  • Perform NASCO benefit file coding and maintenance activities to support healthcare benefit administration.
  • Analyze, implement, and validate group benefit changes and corporate benefit initiatives.
  • Conduct root cause analysis and resolution of benefit configuration and claims processing defects.
  • Support healthcare reform initiatives and benefit-related system enhancements.
  • Perform system analysis, troubleshooting, and impact assessments for benefit and claims processing issues.
  • Execute claims unit testing and validate benefit configuration changes.
  • Collaborate with business stakeholders, developers, quality assurance teams, and project teams to ensure successful implementation of benefit changes.
  • Develop and document business and system requirements related to healthcare benefits processing.
  • Investigate claim processing issues and provide recommendations for corrective actions.
  • Support testing activities by providing test criteria, test scenarios, and implementation guidance.
  • Ensure benefit coding accuracy and alignment with business requirements and regulatory standards.
  • Participate in project meetings, implementation planning, and production support activities.
Required Qualifications
  • Experience with NASCO Benefit File Coding.
  • Strong knowledge of medical claims processing and healthcare benefits administration.
  • Experience supporting healthcare benefits coding and claims processing systems.
  • Strong system analysis, troubleshooting, and problem-solving skills.
  • Experience performing claims testing, benefit validation, and defect analysis.
  • Ability to conduct root cause analysis and recommend solutions for benefit and claims processing issues.
  • Strong analytical, organizational, and communication skills.
  • Experience partnering with both business and technical teams.
  • Experience supporting group benefit change implementations and healthcare-related projects.
  • Ability to manage multiple priorities in a fast-paced environment.
Preferred Qualifications
  • Subject matter expertise supporting MOS and Classic group benefit inquiries and issue resolution.
  • Experience defining test case criteria and supporting systems testing activities.
  • Experience working with cross-functional business, IT, and project teams.
  • Experience within healthcare payer, insurance, or health benefits environments.
  • Knowledge of healthcare benefit configuration and claims adjudication processes.
Education
  • Bachelor's degree in Information Technology, Computer Science, Business, Healthcare Administration, or a related field preferred.
  • Equivalent combination of education and relevant experience will be considered.

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