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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

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

$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

$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

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

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

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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All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Texas

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 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

Configuration Analyst

Texas Children's Hospital

Bellaire, TX • On-site

Full-time

Medical

Posted 5 days ago

Texas Children's Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 176 frontline employees who took The Breakroom Quiz

73rd of 1,060 rated hospitals

Job description


We're searching for a Configuration Analyst, someone who works well in a fast-paced setting. In this position you will be responsible for the activities related to system updates, new health plan implementations and conversions within Business Operations. Designs configurations solutions to meet new business requirements and performs updates for either benefits, coding, contracts, fee schedules or claim editing rules in adherence with business policies and state requirements.
Think you've got what it takes?
Job Duties & Responsibilities
  • Performs daily configuration changes in claim adjudication systems.
  • Analyzes incoming requests and designs configuration solutions to meet business requirements.
  • Performs configuration changes for coding, contracts, benefits, fee schedules and claim editing rules as needed.
  • Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.
  • Maintains thorough and concise documentation for tracking of all contracts, benefit, fee schedule and claim editing rule changes related to Change Control Management or issues for quality audit purposes.
  • Executes configuration changes in an accurate and timely manner to meet the department's standards for quality and service level agreements.
  • Assists with the development of configuration standards and best practices.
  • Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.
  • Monitors pended claims and work queues to update appropriate systems. Responsible for escalating identified issues, making recommendations, and assisting with implementing configuration changes to improve accuracy and efficiency of processes.
  • Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
  • Performs system configuration design analysis associated with projects.
  • Analyzes configuration errors and identifies required modifications.
  • Supports new system implementations and upgrades.

Skills & Requirements
  • Required H.S. Diploma or GED with a preferred bachelor's degree
  • Required 2 years Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules
  • A bachelor's degree may substitute for the required work experience
  • Preferred Skill- Epic Tapestry configuration experience.

About Us
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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