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Claims Configuration Jobs (NOW HIRING)

Computer Task Group, Inc

Epic PB Claims

San Mateo, CA

$75 - $85/hr

Overview CTG is seeking a certified Epic Professional Billing (PB) Claims Build Analyst with 3+ years of hands-on build experience to support the design, configuration, and optimization of Epic ...

Computer Task Group, Inc

Epic PB Claims

San Mateo, CA

$75 - $85/hr

Overview CTG is seeking a certified Epic Professional Billing (PB) Claims Build Analyst with 3+ years of hands-on build experience to support the design, configuration, and optimization of Epic ...

Computer Task Group, Inc

Epic PB Claims

San Mateo, CA · On-site

$75 - $85/hr

CTG is seeking a certified Epic Professional Billing (PB) Claims Build Analyst with 3+ years of hands-on build experience to support the design, configuration, and optimization of Epic billing and ...

Computer Task Group, Inc

Epic PB Claims

San Mateo, CA

$75 - $85/hr

CTG is seeking a certified Epic Professional Billing (PB) Claims Build Analyst with 3+ years of hands-on build experience to support the design, configuration, and optimization of Epic billing and ...

Molina Healthcare

$97.30K - $189.73K/yr

Oversees claims operations and configuration information management as applicable, and collaborates with corporate business owners and centers of excellence (COEs) to ensure the health plan processes ...

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Claims Configuration information

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$35K

$87.9K

$139K

How much do claims configuration jobs pay per year?

As of May 31, 2026, the average yearly pay for claims configuration in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Configuration Specialist, and why are they important?

To thrive as a Claims Configuration Specialist, you need a strong understanding of healthcare claims processing, benefits administration, and insurance terminology, often supported by a degree in healthcare administration or a related field. Familiarity with claims management systems (like Facets or QNXT), SQL, and sometimes certification in medical billing or claims adjudication is typically required. Attention to detail, analytical thinking, and effective communication are standout soft skills for this position. These abilities ensure accurate claims setup and processing, minimizing errors and supporting efficient healthcare operations.

What are the typical challenges faced in a Claims Configuration role, and how can they be effectively managed?

Professionals in Claims Configuration often encounter challenges such as interpreting complex insurance policies, keeping up with frequently changing healthcare regulations, and ensuring accuracy in system setups to prevent claims processing errors. To manage these challenges, strong analytical skills, attention to detail, and ongoing communication with cross-functional teams—such as IT, business analysts, and compliance—are essential. Staying current with regulatory updates and participating in regular training can also help maintain high-quality work and minimize costly claim rework.

What is claims configuration?

Claims configuration refers to the process of setting up and maintaining the rules, parameters, and workflows in a healthcare or insurance system that determine how claims are processed, adjudicated, and paid. This role involves configuring software systems to ensure claims are handled accurately according to plan benefits, provider contracts, and regulatory requirements. Claims configuration specialists work closely with business analysts, IT, and operations teams to implement updates, troubleshoot issues, and support system enhancements. Their work helps streamline claims processing and minimize errors, ensuring compliance and customer satisfaction.

What is the difference between Claims Configuration vs Claims Processing Specialist?

AspectClaims ConfigurationClaims Processing Specialist
Primary RoleSetting up and customizing claims systems and workflowsReviewing, adjudicating, and processing individual insurance claims
Required SkillsTechnical knowledge of claims systems, data managementAttention to detail, knowledge of claims policies, customer service
Work EnvironmentTypically in IT or claims system teams within insurance companiesIn claims departments, interacting directly with claimants and providers
CertificationsClaims system certifications, insurance knowledgeInsurance claims processing certifications, customer service training

Claims Configuration involves setting up and maintaining claims systems to ensure efficient processing, while Claims Processing Specialists handle the day-to-day review and adjudication of claims. Both roles are essential in the insurance industry but focus on different aspects of claims management.

More about Claims Configuration jobs
What cities are hiring for Claims Configuration jobs? Cities with the most Claims Configuration job openings:
What states have the most Claims Configuration jobs? States with the most job openings for Claims Configuration jobs include:
What job categories do people searching Claims Configuration jobs look for? The top searched job categories for Claims Configuration jobs are:
Claims Configuration jobs near you
Infographic showing various Claims Configuration job openings in the United States as of May 2026, with employment types broken down into 91% Full Time, 1% Part Time, and 8% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.
Analyst, Configuration Information Management - Claims Configuration

Analyst, Configuration Information Management - Claims Configuration

Molina Healthcare

Houston, TX • On-site

$54.92K - $107.10K/yr

Full-time

Posted 19 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

145th of 259 rated insurance

Job description

JOB DESCRIPTION 

Provides analystlevel support for Configuration Information Management (CIM) activities, including Directed Payment Program (DPP) and Atlis pricing oversight, ensuring accurate and timely implementation and maintenance of configuration data within claims and operational systems. Responsible for analyzing state and federal requirements, provider contracts, benefits, authorizations, and fee schedules into system configuration parameters. Ensures synchronization across systems, validates configuration accuracy, and supports claims issue resolution to maintain compliance with business, regulatory, and system requirements.

Essential Job Duties

  • Oversight of configuration and maintenance of benefit plans, provider contracts, fee schedules, DPP rate tables, Atlis pricing logic, and supporting system tables within claims platforms (e.g., QNXT, Networx).
  • Analyze and interpret state and federal requirements (Medicaid, Medicare, Marketplace), including Directed Payment Program rules and alternate pricing methodologies (Atlis), and convert these requirements into system configuration parameters.
  • Translate HHSC/CMS guidance, provider contract language, rate exhibits into executable configuration for base rates, addons, and supplemental payments.
  • Ensure configuration aligns with approved payment methodologies and programspecific requirements and maintain Directed Payment Program (DPP) rates and payment structures, including componentbased and retroactive rate updates.
  • Collaborate with Finance, Operations, and Configuration teams to ensure DPP payments are applied correctly and comply with stateapproved methodologies.
  • Perform rootcause analysis to differentiate configuration defects from contract, benefits,  policy, and upstream data issues.
  • Manages fluctuating volumes of work, and prioritizes work to meet deadlines and needs of the configuration department and user community.
     

Required Qualifications

  • At least 2 years of configuration information management experience maintaining databases, and/or analyst experience working within a health care operations setting, or equivalent combination of relevant education and experience.
  • Experience using a claims processing system.
  • Experience verifying documentation related to updates/changes within a claims processing system.
  • Experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements.
  • Analytical and critical-thinking skills.
  • Flexibility to meet changing business requirements, and commitment to high-quality/on-time delivery
  • Strong attention to detail.
  • Effective verbal and written communication skills.  
  • Microsoft Office suite proficiency, including Excel abilities  (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency.
     

Preferred Qualifications

  • Experience in a managed care organization supporting Medicaid, Medicare and/or Marketplace programs.
  • Experience supporting Medicaid Directed Payment Programs (DPP) and/or alternate pricing models.
  • Intermediate to advanced Microsoft Excel skills.
  • Experience with claims root cause analysis and remediation. 
     

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $54,922 - $107,099 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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