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Claim Configuration Analyst Jobs in Oregon (NOW HIRING)

P3 Health Partners

Configuration Manager

Salem, OR · On-site

$100K - $135K/yr

... claim reporting, internal claim reporting and data entry. This role will be responsible for ... Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible ...

P3 Health Partners

Configuration Manager

Salem, OR

... claim reporting, internal claim reporting and data entry. This role will be responsible for ... Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible ...

Careoregon

Payment Integrity Analyst

OR · On-site +1

... Configuration, Finance, Claims and Provider Relations to ensure efforts are in sync. The role is ... Review vendor overpayment suggestions for accuracy, adherence to scope, claim recovery activities ...

Moda Health

Lead Medical Claims Auditor I

Milwaukie, OR

$20.88 - $23.49/hr

Strong analytical, problem solving, and decision-making skills with demonstrated ability to handle ... Claim adjustments and file reviews. * Assist with External Audits * Monitor and maintain unit ...

All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Oregon

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 Oregon?

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

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

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

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

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

Claim Configuration Analyst jobs near you

Configuration Manager

Salem, OR • On-site

P3 Health Partners
Health Care and Social Assistance • 51 - 200 employees

6.6

Company rating: 6.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Learn more about P3 Health Partnersexternal

$100K - $135K/yr

Full-time

Medical

Posted 8 days ago

Job description

Overall Purpose
The main functions of this position are responsible for leading, coaching and guiding staff that implement, support, and maintain the core administrative system configuration including but not limited to: EDI transactions, provider, health plan benefits and member eligibility data, encounters submissions and reconciliations, CMS/health plan claim reporting, internal claim reporting and data entry. This role will be responsible for continuing to enhance the vision, value proposition, services for the configuration function and develop and align the staff in place to deliver against these services.
Essential Functions
  • Coordinate and supervise daily/weekly/monthly activities of a team members including setting priorities for the team to ensure task completion and performance goals are met
  • Respond configuration escalations
  • Provide coaching, feedback, and annual performance reviews as well as formal corrective action
  • Manage inventory and performance to business metrics
  • Write and Submit P&P update requests
  • Provide expertise or general system configuration support to team in reviewing, researching, investigating, system configuration
  • Support team employee engagement
  • Communicate and collaborate with internal and external business partners
  • Document and communicate status of system configuration to stakeholders as needed
  • Achieve applicable performance metrics (productivity, quality, TAT, utilization)
  • Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
  • Understanding of the healthcare industry, including competitors, the regulatory environment, and industry trends
  • Ability to provide strategic leadership and demonstrate the ability to develop future-state scenarios, create a vision for the future, defines factors needed to achieve success, and key actions required.
  • Demonstrated leadership skills having lead configuration activity or function, knowledgeable about configuration best practices, methodologies and tools
  • Other tasks assigned by manager

Knowledge, Skills and Abilities
  • Must have a strong understanding of any local, state and federal rules regarding the adjudication of medical benefits
  • Strong organizational and time management skills with the ability to prioritize individual workloads.
  • Proficient in MS Office with strong computer skills (e.g. multiple systems experiences, keyboarding skills, Microsoft word, Power Point)
  • Strong knowledge of CPT, HCPCS, ICD-10, DRG and APC coding and CMS Guidelines.
  • Ability to drive performance management
  • Ability to interpret electronic data interchange preferred
  • Knowledge of CMS EDI file and submission protocols
  • Knowledge of CMS claim reporting: ODAG and Part C

Experience
  • + 6 years health care administration operational experience
  • 5 years of health care operations and health care system configuration knowledge
  • Experience managing at least six direct reports
  • Extensive experience in plan building, provider data maintenance and reimbursement methodologies including fee schedules, contract management and workflow processes.
  • Experience analyzing and identifying trends preferred

Education
  • High school diploma or GED required
  • Bachelor's degree preferred

Work Location & Schedule
This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.
Pay range: $100,000-135,000 depending on experience
About P3
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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