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Claim Configuration Analyst Jobs in Fall River, MA

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Claim Configuration Analyst information

See Fall River, MA salary details

$15

$41

$68

How much do claim configuration analyst jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for claim configuration analyst in Fall River, MA is $41.47, according to ZipRecruiter salary data. Most workers in this role earn between $30.62 and $53.08 per hour, depending on experience, location, and employer.

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 cities near Fall River, MA are hiring for Claim Configuration Analyst jobs?

Cities near Fall River, MA with the most Claim Configuration Analyst job openings:

Claim Configuration Analyst jobs near you
Infographic showing various Claim Configuration Analyst job openings in Fall River, MA as of August 2026, with employment types broken down into 91% Full Time, and 9% Contract. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $86,265 per year, or $41.5 per hour.

Claims Quality Control Auditor (44912)

Neighborhood Health Plan of Rhode Island

Smithfield, RI

Full-time

Posted 4 days ago

Job description

The Claims Quality Control Auditor ensures organizational claim processing complies with contractual and regulatory requirements.  The position performs audit functions for “internal and external” clients, provides training standards based on findings; creates statistical auditing reports for management; identifies trends and potential issues with claims processing, and recommends process improvements to maximize accuracy.

Duties and Responsibilities

Responsibilities include, but are not limited to the following:

  • Review Neighborhood’s claim process functions, including auto adjudicated and manually processed claims and issues, based on provider and health plan contractual agreements and claims processing guidelines.
  • Adhere to internal processes/procedures that ensure claim auditing functions comply with company policies and procedure standards.
  • Identify trends and patterns in errors and issues found during audit reviews and upchannel to appropriate management. 
  • Prepare written reports on audit findings, scores and corrective actions. 
  • Advise and assist external departments with claims research and processing issues.
  • Identify root cause for claim errors, and collaborate with internal and external departments to develop and implement solutions for resolution of identified issue
  • Review post impact analyses provided by Operations Support to ensure systems upgrades have been configured accurately.  Provide written report to Business Analysts of review results.  Review any problems found with appropriate Business Analyst. 
  • Create Master Impact Analysis (IA) for each processing system.  This Master IA will be created from results of the weekly Claims Adjustment Committee meeting and be used by adjusters from each delegate to reprocess claims according to the respective configuration changes in each system. 
  • Participate in User Acceptance Testing (UAT).  As such, perform analysis and review all upgrade information to ensure accuracy and completeness negating any future claims processing issues.  Identify any errors in claims processing during this testing and provide input to the configuration teams involved. 
  • Complete any ad-hoc audits that approved by Claims management that are requested by upper management, legal, contracting, or any other party within Neighborhood.
  • Identify and communicate ways to improve claims and systems processing accuracy and increase provider/member satisfaction.
  • Report claims with suspected fraud, waste and abuse to management, and submits referrals to Special Investigation Unit.
  • Other duties as assigned

Qualifications

Required:

  • Associates Degree or equivalent relevant work experience in lieu of a degree
  • Minimum 1-3 years directly related experience in medical billing or claim processing
  • Capable of performing mathematical functions (i.e., calculations/discounts/interest commission/percentages, etc.)
  • Intermediate to Advanced skills in Microsoft Office Suite (Excel, Outlook, Word)
  • Data analytics experience
  • Ability to read understand and apply contract terms to claims processing and quality audits
  • Excellent communications skills allowing for the effective description of systems deficiencies and processing errors
  • Ability to work both independently and in a team-based environment
  • Ability to manage multiple projects simultaneously
  • Must exercise excellent judgment and be effective working autonomously and as part of a team
  • Exceptional listening skills and verbal/written communication skills
  • Problem solver with strong attention to detail

Preferred:

  • Certified Professional Coder (CPC) certification
  • 3+ years directly related experience in medical billing or claim processing
  • Knowledge of COGNOS reporting environment
  • Prior experience with Optum Encoder or similar coding program/websites

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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