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Claim Configuration Analyst Jobs in Tennessee (NOW HIRING)

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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?

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 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.
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Claim Configuration Analyst jobs near you

CARR Analyst II

BlueCross BlueShield of Tennessee

Chattanooga, TN

Full-time

Posted yesterday

New

Job description

CARR is seeking a Coding Analyst II to support the Facility Coding & Reimbursement Team!

This role supports facility coding and reimbursement across all lines of business, including contract development, system configuration, code maintenance, medical policy implementation, claim editing, provider disputes, appeals, coding updates, and claims adjudication.

In this position, you will research complex coding and reimbursement issues, evaluate regulatory and industry changes, and collaborate with Claims, Provider Network Management, Medical Policy, Clinical Coding Review, IT, and Customer Service to support payment accuracy, compliance, and reimbursement solutions.

Our ideal candidate will bring:

  • Experience in facility coding and reimbursement, including inpatient and outpatient payment methodologies
  • Experience with claims processing, reimbursement research, regulatory guidance, claims editing, and payment integrity reviews
  • Strong analytical and problem-solving skills with the ability to research and communicate complex reimbursement topics

Additionally, knowledge of MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems is strongly preferred.

Note: Sponsorship is not available for this role.

Job Responsibilities

  • Responsible for the research, design, analysis, recommendation, implementation, problem resolution, maintenance and coordination of coding and reimbursements.
  • Researches and prepares coding and reimbursement policies and procedures and billing guidelines.
  • Coordinates data collection and administrative functions for the implementation of coding, reimbursement, and billing changes; serves in an advisory support capacity regarding coding, reimbursement, and billing issues on various corporate committees, workgroups, and/or sub-workgroups.
  • Assists in the development of educational material to be used for training staff.
  • Provides coding consultations to support company administrative functions and reviews, prioritizes, prepares, and presents recommended code editing changes.

Job Qualifications

Education

  • Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

Experience

  • 3 years - Experience with Medical/Clinical Coding

Skills\Certifications

  • Coding certification from a nationally recognized coding organization (i.e. American Academy of Professional Coders-CPC or CPC-H certification, American Health Information Association CCS-P or CCS certification) is required. If not Coding certified, must be willing to obtain certification within two years of being hired in the position.
  • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
  • Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
  • Must be a team player, be organized and have the ability to handle multiple projects
  • Excellent oral and written communication skills
  • Strong interpersonal and organizational skills
  • Knowledge and understanding of claims, customer service, member benefits, authorization, and reimbursement applications and configuration.
  • Knowledge and understanding of BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies for at least one of the following specialty areas is required: Professional services, Facility services or Home Health services.
  • Basic knowledge and understanding of Health Insurance Portability and Accountability Act (HIPAA) standardized claims transaction and medical/clinical

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

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