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Claim Configuration Analyst Jobs in Wisconsin (NOW HIRING)

Mercyhealth

Internal Auditor

Janesville, WI · On-site

$58K - $94K/yr

Analyze audit results, identify trends and areas of risk, and prepare detailed written reports ... configuration. * Research claim processing issues and errors to determine their origin and ...

Mercyhealth

Internal Auditor

Janesville, WI · On-site

$58K - $94K/yr

Analyze audit results, identify trends and areas of risk, and prepare detailed written reports ... configuration. * Research claim processing issues and errors to determine their origin and ...

Imedica

Director, Claims Operations

Madison, WI

$113K - $194K/yr

... recovery, claim analysis and issue resolution, and provider appeals. A skilled people and ... Partner cross-functionally (Payment Integrity, Customer Service, EDI, Configuration, Finance, IT, ...

All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Wisconsin

Claim Configuration Analyst information

What are Claim Configuration Analysts?

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 does a configuration analyst do?

A claim configuration analyst is responsible for setting up and maintaining claim processing systems, ensuring accurate claim adjudication and compliance with policies. They analyze system configurations, troubleshoot issues, and often use specialized software or tools to optimize claim workflows. Strong attention to detail and knowledge of insurance or healthcare systems are essential for this role.

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 does a claims analyst do?

A claims analyst reviews and processes insurance claims to determine their validity and appropriate payout. They analyze claim details, ensure compliance with policies, and use data management tools to identify discrepancies or fraud, supporting accurate and efficient claims resolution.

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 jobs pay $500,000 a year in the US?

Claim Configuration Analysts typically do not earn $500,000 annually; such high salaries are usually associated with executive roles, specialized surgeons, or successful entrepreneurs. High-paying jobs often require advanced skills, extensive experience, or ownership of a business. Compensation at this level is rare in standard analyst positions and more common in executive leadership or highly specialized fields.

Is SOC an entry level job?

A SOC (Security Operations Center) analyst role is typically considered an entry to mid-level position, depending on the organization. Entry-level SOC analysts usually require basic knowledge of cybersecurity concepts, monitoring tools, and incident response, with opportunities for certification such as CompTIA Security+ to advance. Experience requirements vary, but many organizations offer training for new analysts.
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Claim Configuration Analyst jobs near you

Claims Supplier Management Analyst

Sentry

Stevens Point, WI • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Oversees the operational and strategic management of the claims supplier portfolio to optimize the value, cost, and risk.
This role will report to our Stevens Point, WI office.
What You'll Do:
Our Claims Supplier Management Analyst will oversee the operational and strategic management of the claims supplier portfolio to optimize the value, cost, and risk. You will collaborate with claims management (supplier relationship and application owners), IT management, and corporate procurement in supplier acquisition, compliance, maintenance renewals, service level agreement adherence, and more.
In addition, you will...
  • Maintain a comprehensive listing and overview of claims suppliers and services.
  • Compile and monitor supplier contract dates and provide timely awareness of renewal dates to enable visibility of key contract items such as contract terms, pricing, current costs, and SLA Adherence.
  • Coordinate quarterly business reviews/annual reviews/partnership reviews and support monthly invoicing as applicable.
  • Identify potential supplier opportunities, compile a comparison analysis, and coordinate discovery discussions between claims, IT, procurement and suppliers.
  • Provide support during the audits and assist with dispute resolution.
  • Contribute to the development and implementation of supplier management strategies and approaches to minimize compliance and security risks.

What it Takes:
  • Bachelor's degree or equivalent work experience
  • Minimum 3 years of related work experience, experience in software asset management and licensing is strongly preferred.
  • Certified Software Asset Manager certification preferred.
  • Strong quantitative, analytical, and problem-solving skills.
  • Knowledge of software asset management tools technologies, and principles/practices.
  • Familiarity with hardware technology and configurations including virtualization; experience with and/or understanding of configuration management database documentation.
  • Proven ability to engage others in collaborating to resolve problems/issues.
  • Knowledge of product use rights for software publishers and understanding software contractual agreements and compliance.
  • Proficiency with excel, specifically pivot tables, v-lookups, and functional agreements.

What You'll Receive:
At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you'll receive.
  • Sentry is happy to offer flexibility through a scheduled Hybrid work model. Monday and Friday work from home if you choose to, Tuesday through Thursday you'll work in office.
  • As a Sentry associate, you will have an in-office workspace and materials for your home office. In addition to the laptop, you will receive prior to your start, Sentry will provide equipment for your home office.
  • Meal Subsidy available for associates who report to an office.
  • 401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting to help strengthen your financial future.
  • Continue your education and career development through Sentry University (SentryU) and utilize our Tuition Reimbursement program
  • Generous Paid-Time Off plan for you to enjoy time out of the office as well as Volunteer-Time off
  • Group Medical, Dental, Vision, Life insurance, Parental leave, and our Health and Wellness benefits to encourage a healthy lifestyle.
  • Well-being and Employee Assistance programs
  • Sentry Foundation gift matching program to encourage charitable giving.

About Sentry:
We take great pride in making Forbes' list of America's Best Midsize Employers. A lot of different factors go into that honor, many of which contribute to your job satisfaction.
Our bright future is built on a long track record of success. We got our start in 1904 and have been helping businesses succeed and protect their futures ever since. Because of the trust placed in us, we're one of the largest and financially strongest mutual insurance companies in the United States.
We're rated A+ by A.M. Best, the industry's leading rating authority.
Our headquarters is in Stevens Point, Wisconsin, with offices located throughout the United States. From sales to claims, and information technology to marketing, we enjoy a rewarding and challenging work environment with opportunities for ongoing professional development and growth.
Get ready to own your future at Sentry. Opportunities await!
Jessica Welsh
HR Specialist
jessica.welsh@sentry.com
Equal Employment Opportunity
Sentry is an Equal Opportunity Employer. It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.

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