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Claim Configuration Analyst Jobs in Ohio (NOW HIRING)

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 ...

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 ...

CareSource

Operations Specialist II

Dayton, OH · On-site +1

$62K - $100K/yr

Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data. * Perform analysis of all claims data in order to provide decision ...

Unlimited Systems

DevOps Engineer (Hybrid)

Cincinnati, OH · On-site

$50.75 - $69.50/hr

Managing and analyzing Azure Kubernetes Service (AKS) resources to support application availability ... Managing DNS configuration and SSL certificate lifecycle across environments * Managing Web ...

Unlimited Systems

DevOps Engineer (Hybrid)

Cincinnati, OH · On-site

$50.75 - $69.50/hr

Managing and analyzing Azure Kubernetes Service (AKS) resources to support application availability ... Managing DNS configuration and SSL certificate lifecycle across environments * Managing Web ...

All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Ohio

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 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]

Sr. Configuration Analyst[Hybrid]

SmartIPlace

Mason, OH • On-site

Contractor

Posted 21 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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