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Claim Configuration Analyst Jobs in Texas (NOW HIRING)

University Health

Claims Analyst

San Antonio, TX

We are looking for an experienced Claims Analyst for our Claims department with Community First ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX

$20.30 - $33/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$19.80 - $31.25/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$19.80 - $31.25/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$20.30 - $33/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$19.80 - $31.25/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX

$20.30 - $33/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$19.80 - $31.25/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$20.30 - $33/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$19.80 - $31.25/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX

$19.80 - $31.25/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

University Health

Claims Analyst

San Antonio, TX · On-site

$20.30 - $33/hr

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments ... claim issue resolution. Work cooperatively with Configuration in testing of contracts used in ...

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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.
What are popular job titles related to Claim Configuration Analyst jobs in Texas? For Claim Configuration Analyst jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Claim Configuration Analyst jobs in Texas look for? The top searched job categories for Claim Configuration Analyst jobs in Texas are:
What cities in Texas are hiring for Claim Configuration Analyst jobs? Cities in Texas with the most Claim Configuration Analyst job openings:
Claim Configuration Analyst jobs near you

Payment Integrity Analyst I-HP Benefit Configuration

CHRISTUS Health

Irving, TX • On-site

Full-time

Re-posted 11 days ago

CHRISTUS Health rating

6.7

Company rating: 6.7 out of 10

Based on 528 frontline employees who took The Breakroom Quiz

530th of 887 rated healthcare providers

Job description

Summary:
Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization Management, as well as other operational departments to ensure validation and quality assurance of benefit, contract, reimbursement, and overall financial analysis that arise during the overpayment identification and recovery process.
Responsibilities:
  • Identify, analyze, and interpret trends or patterns in complex data sets.
  • Leverages available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution; documents all activity in accordance with organization policies.
  • Performs review of claim projects resulting from overpayments or underpayments related to benefits, contracts, and fee schedule defects.
  • Performs root cause analysis and financial impacts of identified defective claims.
  • Communicates findings, including trends and recommendations to appropriate leadership.
  • Research, maintain, test, and create fee schedule tables from data obtained from CMS, Tricare (CHAMPUS), or custom rates into the claims system.
  • Research, maintain, and create provider reimbursement contract configuration.
  • Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals.
  • Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
  • All other duties assigned by management.

Requirements:
Education/Skills
  • High school diploma or equivalent experience in healthcare claims adjudication, system configuration, and auditing
  • Strong understanding of healthcare claims data, pricing, and claims editing concepts, including UB04 and HCFA 1500 claim content
  • Strong working knowledge of health insurance concepts, practices, and procedures, including the understanding of provider payment methodologies and claims processing workflows, from receipt through final adjudication
  • Strong analytical and research abilities to triage issues and perform reconciliations or data analysis
  • Working knowledge of Federal and State regulatory rules regarding claims adjudication
  • Ability to organize and prioritize work to meet deadlines
  • Strong Microsoft Office application skills, including Microsoft Word and Excel (VLOOKUP, Pivot Tables, Index/Match, Formulas, and creating spreadsheets)
  • Strong organizational skills and the ability to manage multiple competing projects and deadlines
  • Ability to think creatively
  • Excellent written and verbal communication skills
  • Good judgment, initiative, and problem-solving abilities
  • Ability to handle and resolve complex issues independently
  • Knowledge of Commercial, Medicare Advantage, Tricare, and Health Care Exchange programs preferred
  • Knowledge of CPT/HCPCS, ICD-10 coding, and medical terminology.
  • Ability to learn new policies and processes based on written material and observation
  • Ability to establish and maintain professional, positive, and effective work relationships
  • Demonstrated ability to collaborate effectively and work as part of a team in a fast-changing environment

Experience
  • 0-1 year of experience interpreting complex provider agreements, claims adjudication, system configuration, and auditing.

Work Schedule:
MULTIPLE SHIFTS AVAILABLE
Work Type:
Full Time

What CHRISTUS Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

CHRISTUS Health logo

About CHRISTUS Health

Sourced by ZipRecruiter

CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.

Industry

Outpatient health care

Company size

1,001 - 5,000 Employees

Headquarters location

Irving, TX, US

Year founded

1999

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