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Claim Configuration Analyst Jobs (NOW HIRING)

Techvilla Solutions

  • Medical

Perform SQL queries to validate configuration data, troubleshoot issues, and analyze claim outcomes. * Participate in release deployments and post-production validation activities. * Collaborate with ...

Techvilla Solutions

  • Medical

Perform SQL queries to validate configuration data, troubleshoot issues, and analyze claim outcomes. * Participate in release deployments and post-production validation activities. * Collaborate with ...

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Claim Configuration Analyst information

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How much do claim configuration analyst jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for claim configuration analyst in the United States is $41.31, according to ZipRecruiter salary data. Most workers in this role earn between $30.53 and $52.88 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 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.
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Claim Configuration Analyst jobs near you
Infographic showing various Claim Configuration Analyst job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 86% Full Time, 6% Part Time, and 7% Contract. Highlights an 81% Physical, 9% Hybrid, and 10% Remote job distribution, with an average salary of $85,935 per year, or $41.3 per hour.

QNXT Benefit Configuration Analyst

Techvilla Solutions

Middle Village, NY • Remote

Full-time

Medical

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

Job description

Position Overview

We are seeking an experienced  QNXT Benefit Configuration Analyst  to support the implementation, enhancement, and maintenance of benefit plans within the  TriZetto QNXT  platform. The ideal candidate will have extensive experience configuring commercial and/or government healthcare products, translating business requirements into system configurations, and collaborating with cross-functional teams to deliver high-quality healthcare solutions.  

The candidate should possess strong knowledge of healthcare payer operations, benefit plan design, claims processing, SQL, and end-to-end testing.

Roles and Responsibilities
  • Configure and maintain benefit plans within the QNXT platform based on business and regulatory requirements. 
  • Configure Service Groups, Restriction Groups, Copay Groups, Coinsurance, Deductibles, Out-of-Pocket Maximums (MOOP), Accumulators, Visit Limits, Authorization Rules, and Benefit Limits. 
  • Configure benefits for Commercial, Medicare Advantage, Medicaid, Exchange, PPO, HMO, POS, EPO, and ASO products. 
  • Analyze business requirements and translate them into detailed configuration specifications. 
  • Collaborate with Business Analysts, Product Owners, Configuration Analysts, Developers, QA, and Business Stakeholders. 
  • Perform impact analysis for new benefit changes, regulatory updates, and annual benefit plan implementations. 
  • Support annual benefit rollovers and Open Enrollment implementations. 
  • Validate benefit configurations using the QNXT Claims module to ensure claims adjudicate correctly. 
  • Develop configuration documentation, design documents, mapping documents, and implementation guides. 
  • Troubleshoot benefit configuration issues and identify root causes. 
  • Support production incidents and resolve benefit configuration defects. 
  • Participate in requirements gathering sessions, JAD sessions, backlog grooming, sprint planning, and release planning. 
  • Work closely with QA teams during SIT, UAT, and regression testing. 
  • Perform SQL queries to validate configuration data, troubleshoot issues, and analyze claim outcomes. 
  • Participate in release deployments and post-production validation activities. 
  • Collaborate with downstream teams supporting Claims, Enrollment, Provider, Finance, EDI, and Customer Service. 
  • Maintain configuration version control using QCS, CMT, or other migration tools. 
  • Ensure compliance with CMS, State Medicaid, and Commercial regulatory requirements. 
Required Qualifications
  • 5+ years of Healthcare Payer experience. 
  • 5+ years of hands-on TriZetto QNXT Benefit Configuration experience. 
  • Strong understanding of healthcare benefit design and claims adjudication. 
  • Experience configuring: 
    • Service Groups 
    • Restriction Groups 
    • Copay Groups 
    • Coinsurance 
    • Deductibles 
    • Accumulators 
    • MOOP 
    • Visit Limits 
    • Prior Authorization Rules 
    • In-Network / Out-of-Network Benefits 
  • Experience with Commercial, Medicare, and Medicaid benefit plans. 
  • Strong SQL skills including: 
  • Experience troubleshooting claims adjudication issues. 
  • Experience validating benefit configurations using test claims. 
  • Ability to read and interpret business requirements and technical documentation. 
  • Strong analytical and problem-solving skills. 
  • Excellent communication and stakeholder management skills. 
Preferred Qualifications
  • Experience with QCS (QNXT Configuration Studio). 
  • Experience with CMT (Configuration Migration Tool). 
  • Experience supporting annual benefit implementations. 
  • Experience with Medicare Advantage and Medicaid Managed Care plans. 
  • Experience with CMS regulations. 
  • Experience working in Agile/Scrum environments. 
  • Experience using Jira, Azure DevOps, or Rally. 
  • Experience supporting large healthcare payer organizations. 

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