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Claim Configuration Analyst Jobs in Ohio (NOW HIRING)

CareSource

Team Lead, Configuration

Dayton, OH · On-site

$83 - $133/hr

Develop and utilize reports to analyze and stratify data to address gaps and provide answers to ... Each claim, each phone call, each consumer-centric decision is a chance to change the world for one ...

New

AVA Consulting

Data Analyst

Mason, OH · On-site

Serve as a Data Analyst on the Business Configuration team, responsible for the structure, and ... Experience understanding claim adjudication for member and provider reimbursements. * Experience ...

New

Forhyre

OH

This role will also provide analysis related to the identification of improved claim system configuration and call flows that would positively impact quality performance , reduce claim inventory and ...

Belcan

Data Analyst

Mason, OH · On-site

$47.20/hr

GENERAL FUNCTION Serve as a Data Analyst on the Business Configuration team, responsible for the ... Experience understanding claim adjudication for member and provider reimbursements. * Experience ...

Belcan

Data Analyst

Mason, OH · On-site

$47.20/hr

GENERAL FUNCTION Serve as a Data Analyst on the Business Configuration team, responsible for the ... Experience understanding claim adjudication for member and provider reimbursements. * Experience ...

New

Belcan, LLC

Data Analyst

Mason, OH · On-site

$47.20/hr

GENERAL FUNCTION Serve as a Data Analyst on the Business Configuration team, responsible for the ... Experience understanding claim adjudication for member and provider reimbursements. * Experience ...

New

CYNET SYSTEMS

Data Analyst Operations

Mason, OH · On-site

$42.20 - $47.20/hr

Serve as a Data Analyst on the Business Configuration team, responsible for the structure and ... Experience understanding claim adjudication for member and provider reimbursements. Experience with ...

New

CYNET SYSTEMS

Data Analyst Operations

Mason, OH · On-site

$42 - $47/hr

Serve as a Data Analyst on the Business Configuration team, responsible for the structure and ... Experience understanding claim adjudication for member and provider reimbursements. * Experience ...

New

Real Soft, Inc.

IT - Data Analyst

Mason, OH · On-site

$65/hr

Provide subject matter expertise for product configuration in the Facets system. Partner with ... claim adjudication for member and provider reimbursements. • Experience with Facets platform ...

Apex Informatics

Data Analyst

Mason, OH · On-site

Experience understanding claim adjudication for member and provider reimbursements. * Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration * Knowledge of ...

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All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Ohio

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 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.

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.

Is claims processing a stressful job?

Claims processing as a Claim Configuration Analyst can be stressful due to tight deadlines, high accuracy requirements, and the need to resolve complex issues efficiently. The role often involves detailed data analysis and communication with stakeholders, which can contribute to work-related stress. 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 Ohio?

For Claim Configuration Analyst jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Claim Configuration Analyst jobs in Ohio look for?

The top searched job categories for Claim Configuration Analyst jobs in Ohio are:

What cities in Ohio are hiring for Claim Configuration Analyst jobs?

Cities in Ohio with the most Claim Configuration Analyst job openings:

Claim Configuration Analyst jobs near you

Sr. Configuration Analyst[Hybrid]

SmartIPlace

Mason, OH • On-site

Contractor

Re-posted 15 days ago

Job description

Role: Sr. Configuration Analyst
Location: Hybrid – 2x a week onsite – Mason, Ohio
Duration: 12months
Visa: GC, USC

Interview: Video
***MUST BE LOCAL TO MASON, OH **
Job Description:
Must have: This role is about 60% configuration 40% attending cross functional meetings and capture requirements.
Able to lead/represent cross functional meetings (this is one of the major skill set that we look for).
Require high level roles to build, troubleshoot, and prototype Medicaid products. Capture business requirements with clients, testing execution, and troubleshooting for multiple Medicaid program implementations.
Top 3-5 mandatory and/or minimum requirements:
• SQL
• SQL/Database experience.
• Healthcare claim understanding/benefit configuration.
• Facets
• Informatica
• Analytical & problem-solving skill Operating System: Windows Applications: Facets Automation tools:
• Testing tools: Oracle SQL for data validation and Facets for claims testing.
Top 3-5 desirable attributes/qualifications?
• 5+ years’ experience w/:
o Facets platform
o Medical Plan Benefit Configuration
o Provider Network & Agreement Configuration
o Understanding for Medicare/Medicaid.
o SQL and Database experience

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About Smart-iPlace

Sourced by ZipRecruiter

SMART-iPLACE provides innovative staffing and consulting solutions that help our clients achieve their business objectives. We can understand and support all areas of your IT systems from back-end infrastructure to front-end personal productivity. Our goal is create innovative IT solutions that enable your business to be more agile and competitive.

Industry

It services

Company size

51 - 200 Employees

Headquarters location

Irving, TX, US

Year founded

2021

Social media

Facebook

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