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Claim Configuration Analyst Jobs in Texas (NOW HIRING)

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 ...

Computer Futures

Health Insurance Analyst

Dallas, TX · On-site

$19.75 - $27/hr

Process of a claim once it is submitted. Knowledge of the lifecycle from when it is submitted in to ... Data, Configuration, or Enrollment) Compliments the team and environment by being professional ...

AArete

Senior Pharmacy Data Analyst

Dallas, TX · On-site

$125K - $140K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Support pharmacy plan, client, and contract configuration activities through analytic review, testing, and validation of claim outcomes * Validate data quality, completeness, and reasonableness of ...

Careington

Claims Finance Manager

Frisco, TX

  • Medical

  • Dental

  • Vision

... analyzing claim costs, reimbursement trends, adjudication outcomes, reserve impacts, and operational performance. The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration ...

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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

Claims Analyst

University Health

San Antonio, TX

$20.30 - $33/hr

Full-time

Re-posted 13 days ago

University Of Nevada (Reno) rating

8.5

Company rating: 8.5 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

80th of 620 rated colleges and universities

Job description

POSITION SUMMARY/RESPONSIBILITIES
Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP. Operate under limited supervision.

EDUCATION/EXPERIENCE
High school diploma or GED equivalent is required. Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred. Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.

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