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Claims Configuration Jobs (NOW HIRING)

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 ...

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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 Jun 26, 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 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.

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 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.
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 June 2026, with employment types broken down into 97% Full Time, 1% Part Time, and 2% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.
Program Manager (Claims - MST hours)

Program Manager (Claims - MST hours)

Molina Healthcare

Roswell, NM

$66K - $129K/yr

Full-time

Posted 5 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

144th of 262 rated insurance

Job description

JOB DESCRIPTION

Job Summary

Provides support to Molina functional areas (Claims, and claims configuration) through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable. 

Job Duties

  • Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective claims & claims configuration program.     
  • Manages program budget, as applicable, supporting project prioritization.
  • Collaborates with Legal, Compliance, and Information Security to ensure governance standards are upheld.
  • Tracks performance metrics and ensures value realization from deployed solutions. 
  • Coordinates recurring meetings to support governance framework and decision-making processes, as needed. 
  • At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management.
  • Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral.
  • Routinely reviews program collateral to ensure current and accurate reflection of business needs. 
  • Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team. 
  • Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
  • Generates and distributes standard reports on schedule.

JOB QUALIFICATIONS

REQUIRED QUALIFICATIONS:

  • At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience.
  • Operational Process Improvement experience.
  • Managed Care experience, preferably in a shared service, CoE or matrixed environment.
  • Experience with Microsoft Project and Visio. 
  • Strong presentation and communication skills.

PREFERRED QUALIFICATIONS:

  • Clams & claims configuration experience.
  • QNXT
  • Provider Relations

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: $66,456 - $129,590 / 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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Benefits

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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