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Claims Configuration Jobs in Indiana (NOW HIRING)

Local Indianapolis organization

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Claims Lead

Indianapolis, IN · On-site

$60K - $63K/yr

As a Claims Medical Processor, a qualified candidate will work within our growing Health Benefit ... Understand and update claim system configuration. * Process claim adjustments, voids, and refunds.

ClinDCast LLC

Epic HB Analyst

Zionsville, IN · On-site

... claims, billing edits, and workflows. * Analyze business and billing requirements and translate them into Epic system build and configuration. * Support end-to-end revenue cycle workflows including ...

Deloitte

Unqork Business Analyst

Indianapolis, IN · On-site

... claims, billing, underwriting, or distribution * 1+ Unqork implementation involving requirements traceability, configuration support, and user acceptance testing * 1+ project involving application ...

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Claims Configuration information

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.
What are popular job titles related to Claims Configuration jobs in Indiana? For Claims Configuration jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Claims Configuration jobs in Indiana look for? The top searched job categories for Claims Configuration jobs in Indiana are:
What cities in Indiana are hiring for Claims Configuration jobs? Cities in Indiana with the most Claims Configuration job openings:
Claims Configuration jobs near you

Claims Lead

Local Indianapolis organization

Indianapolis, IN • On-site

$60K - $63K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

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Job description

As a Claims Medical Processor, a qualified candidate will work within our growing Health Benefit Fund team supporting our wide array of union members. Member services standard hours are between 8 - 5 pm. This is an in-house, onsite position.

Responsibilities:

  • Accurately process claims by researching benefits, claim policies, procedure and reviewing claim edits.
  • Answer incoming telephone calls to assist customers with explanations and issue resolution of healthcare policies, benefits, eligibility and coverage.
  • Understand and update claim system configuration.
  • Process claim adjustments, voids, and refunds.
  • Maintain claim resources, reference materials and training tools.
  • Manage daily workloads to ensure production goals are met and calls are resolved timely.
  • Verify accurate data entry, to include correct patient, coding, dollar amounts and provider information.
  • Maintain accuracy levels of 98% or higher for both payment and statistical data.
  • Work in assigned work groups/queues and assist in other areas as needed.
  • Work closely with senior staff, maintaining daily communication/updates.
  • Ability to train and coach others.
  • Ability to handle more complex cases and serve as a subject matter expert.
  • Perform other duties as assigned.

Required Qualifications:

  • High School Diploma or equivalent.
  • Knowledge of medical/insurance terminology.
  • Extensive knowledge of ICD-10, CPT, and CDT.
  • Excellent customer service – member first mentality
  • Research skills and ability to evaluate claims in order to resolve accurately.
  • Ability to interpret health plan contracts and benefit language.
  • Excellent oral and written communication skills that are shown in a respectful, pleasant and professional manner.
  • Work habits that include punctuality, ability to be a team player, willing to assist and support peers, as well as work independently with minimal direction.
  • Excellent negotiation, analytical, and problem solving skills.
  • Ability to prioritize workloads and perform under time pressures.

Preferred Qualifications:

  • Five years’ experience as claims processor
  • Ability to determine and process Coordination of Benefits, claims adjustments, and stop loss coverages.
  • Experience performing claim audits.
  • Experience taking inbound calls.