Analyze vendor bulletins, regulatory updates, and system changes to assess impact on internal ... Identify claim data characteristics required for testing pricing logic and configuration accuracy.
Analyze vendor bulletins, regulatory updates, and system changes to assess impact on internal ... Identify claim data characteristics required for testing pricing logic and configuration accuracy.
Directs analytical activities to identify trends and potential opportunities with corporate ... Directly manages the plan's benefit configuration, claim payment policies and the maintenance or ...
Directs analytical activities to identify trends and potential opportunities with corporate ... Directly manages the plan's benefit configuration, claim payment policies and the maintenance or ...
... system configuration and testing, develop workflows, create claims procedures and training ... Partner closely with Product Owners, Business Analysts, Technology teams, and external vendors to ...
... system configuration and testing, develop workflows, create claims procedures and training ... Partner closely with Product Owners, Business Analysts, Technology teams, and external vendors to ...
... system configuration and testing, develop workflows, create claims procedures and training ... Partner closely with Product Owners, Business Analysts, Technology teams, and external vendors to ...
... system configuration and testing, develop workflows, create claims procedures and training ... Partner closely with Product Owners, Business Analysts, Technology teams, and external vendors to ...
... system configuration and testing, develop workflows, create claims procedures and training ... Partner closely with Product Owners, Business Analysts, Technology teams, and external vendors to ...
... system configuration and testing, develop workflows, create claims procedures and training ... Partner closely with Product Owners, Business Analysts, Technology teams, and external vendors to ...
... configuration, claim payment policies and the maintenance or modification of such, to support ... analysts to audit provider contract loads and claims payments to ensure compliance with provider ...
... configuration, claim payment policies and the maintenance or modification of such, to support ... analysts to audit provider contract loads and claims payments to ensure compliance with provider ...
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?
| 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 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.
What are popular job titles related to Claim Configuration Analyst jobs in Nebraska?
For Claim Configuration Analyst jobs in Nebraska, the most frequently searched job titles are:
What job categories do people searching Claim Configuration Analyst jobs in Nebraska look for?
The top searched job categories for Claim Configuration Analyst jobs in Nebraska are:
What cities in Nebraska are hiring for Claim Configuration Analyst jobs?
Cities in Nebraska with the most Claim Configuration Analyst job openings:
Full-time
Medical, Life, Retirement, PTO
Posted 19 days ago
Signature Performance rating
6.6
Based on 8 frontline employees who took The Breakroom Quiz
312th of 492 rated business services
Job description
About You
The Payer Payment and Reimbursement Analyst will work with the team members in healthcare payment & reimbursement methodologies, laws and regulations under the mentorship and guidance of the Project Manager.
- Tell us about your experience with Payment and Reimbursement Methodologies.
- Are you a team player and a self-motivator?
- What is your experience with conducting business in a way that is credit to a company?
- We are counting on you to manage multiple projects using your problem-solving skills.
- We are looking for someone UNCOMMON. What is uncommon about you?
Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you.
About the Position
- Configure and maintain payment, pricing, and contract logic within healthcare reimbursement systems to ensure accurate claims adjudication.
- Analyze vendor bulletins, regulatory updates, and system changes to assess impact on internal processes, products, and data systems.
- Review and evaluate large healthcare data sets to identify trends, anomalies, and required system or process changes.
- Interpret Medicare, VA, CHAMPVA, and TRICARE policies, including rulings, transmittals, bulletins, manuals, and physician fee schedule data files.
- Collaborate directly with government agencies to clarify new or existing reimbursement and payment policies.
- Translate reimbursement policy updates and payment methodology changes into clear, actionable business requirements for software design and system configuration.
- Develop complex Excel models and formulas to validate, explain, and support payment methodologies.
- Identify claim data characteristics required for testing pricing logic and configuration accuracy.
- Partner with Developers, QA, Data, and Client Services teams to ensure requirements are implemented accurately and on schedule.
- Create and execute test claims for development, UAT, QA, and configuration validation.
- Perform configuration testing and troubleshoot pricing or payment discrepancies.
- Maintain deep knowledge of company products, data, and services, including commercial contracting and reimbursement features.
- Independently evaluate and resolve complex pricing and reimbursement issues while managing multiple priorities.
Core Competencies
- Strong analytical and critical-thinking skills
- High attention to detail and quality
- Ability to synthesize complex policy and data into practical solutions
- Effective collaboration and communication
- Self-directed with strong prioritization skills
Minimum Requirements
- 3-4 years of professional experience in healthcare provider payment and reimbursement.
- Working knowledge of healthcare billing, compliance, and payer reimbursement regulations.
- Experience with professional and institutional payment fee schedules, including but not limited to:
- Experience with Prospective Payment Systems (PPS), including:
- DRG, OPPS, Skilled Nursing, Home Health, Hospice, and ASC
- Experience with Prospective Payment Systems (PPS), including:
- Knowledge of:
- Critical Access, Sole Community
- Behavioral Health
- Inpatient Rehabilitation/Outpatient Rehabilitation
- Long Term Care Hospital
- Federally Qualified Health Center
- Physician Fee Schedule, DME/DEMPOS, Ambulance, AWP, Lab, ESRD, Hospice, Home Health, Anesthesia, ADA
- Integrated Outpatient Code Editor (I/OCE)
- Ability to collect, research, interpret, and document complex information into clear and concise business requirements.
- Strong interpersonal and cross-functional collaboration skills.
- Working knowledge of provider types, specialties, and their applicable reimbursement methodologies.
- Ability to communicate effectively with diverse internal and external stakeholders.
- SQL reporting experience preferred.
Preferred Requirements
- Proficiency in Microsoft Office applications (Teams, Word, Excel, PowerPoint, Visio, Access).
- Experience using web-based research tools and regulatory resources.
- Knowledge of claims adjudication and payment workflows.
- Experience configuring TriZetto Facets NetworX.
- Experience configuring Optum Rate Manager.
About Us
You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better. As we continue to experience exponential growth, we are looking for uncommon individuals to enhance our vision. We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization. We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.
About the Benefits
When you are a member of Signature Performance, you are a part of a solutions-based organization where the values of passion, integrity, courage, and respect are the driving forces behind all our decision-making. We trust you to do important work and bring the best version of yourself to work every day, so we want to help you achieve a work-life balance while consistently challenging yourself. Signature believes in fully developing each one of our Associates. Our performance-driven philosophy boasts competitive pay and additional position specific incentives, where world-class training and development, resources, and events drive our award-winning culture where everyone thrives.
- Health Insurance
- Fully Paid Life Insurance
- Fully Paid Short- & Long-Term Disability
- Paid Vacation
- Paid Sick Leave
- Paid Holidays
- Professional Development and Tuition Assistance Program
- 401(k) Program with Employer Match
- U.S. Citizenship or naturalized citizenship is required for this position.
- All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.
What Signature Performance employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Signature Performance
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Omaha, NE, US
Year founded
2004