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Claims Configuration Jobs in Ohio (NOW HIRING)

CareSource

Operations Specialist II

Dayton, OH · On-site +1

$62K - $100K/yr

Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data. * Perform analysis of all claims data in order to provide decision ...

Apex Informatics

Data Analyst

Mason, OH · On-site

Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration * Knowledge of Medicare and Medicaid programs * SQL and Database experience

Deloitte

Guidewire Architect

Columbus, OH

$60.75 - $80.25/hr

CPCU, AIC, ARM, and/or Guidewire Integration or Configuration certification * 4+ years of experience with Guidewire Cloud Claims migration * Experience delivering projects using Agile/Scrum ...

Deloitte

Guidewire Architect

Cleveland, OH

$61 - $80.50/hr

CPCU, AIC, ARM, and/or Guidewire Integration or Configuration certification * 4+ years of experience with Guidewire Cloud Claims migration * Experience delivering projects using Agile/Scrum ...

Deloitte

Guidewire Architect

Cincinnati, OH

$60.50 - $79.75/hr

CPCU, AIC, ARM, and/or Guidewire Integration or Configuration certification * 4+ years of experience with Guidewire Cloud Claims migration * Experience delivering projects using Agile/Scrum ...

Forhyre

OH

... claims and first call resolution . This role will also provide analysis related to the identification of improved claim system configuration and call flows that would positively impact quality ...

Volto USA

Oracle eBS R12 Financials

Cleveland, OH · On-site

$59 - $72.75/hr

Experience with Claims Management (pricing claims, short payments, deductions, dispute resolution ... Lead Oracle AR, Cash Management, and EB Tax configuration and solution design Gather requirements ...

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All JobsClaims Configuration JobsClaims Configuration Jobs in Ohio

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

Healthcare Configuration Consultant / Analyst (Facets & SQL)

Azaaki LLC

Mason, OH • Hybrid

$50 - $60/hr

Contractor

Posted 28 days ago

Job description

Healthcare Systems Configuration Analyst (FACETS, SQL)

Location: Mason, OH 45040 (Hybrid – 3 days per week onsite - Mason, OH)

Duration: 6 Months with Possible extension

Work Hours: 8:00 AM – 5:00 PM (1-hour break)

Weekly Hours: 40 hours

Experience & Education

  • Experience Required: 6+ years
  • Education: Bachelor’s degree or equivalent work experience (flexible)

ROLE SUMMARY

  • Serve as a Sr. Configuration Analyst on the Business Configuration Solutions team, responsible for enabling member benefit configuration strategies by designing, implementing, and executing configuration solutions.
  • This role is 60% hands-on configuration and 40% cross-functional collaboration, including leading meetings, capturing business requirements, testing execution, and troubleshooting Medicaid product implementations.
  • The analyst will act as a Subject Matter Expert (SME) interfacing with cross-functional teams to deliver system and process solutions using FACETS and supporting automation tools.

Key Responsibilities

  • Serve as a Subject Matter Expert representing the Configuration workstream for large Government Implementations (Medicaid, Medicare, Med/Surgical).
  • Design, build, troubleshoot, and prototype Medicaid products using FACETS.
  • Lead and represent cross-functional meetings to gather and document business requirements.
  • Capture and document business requirements, process flows, and functional specifications.
  • Execute testing, claims validation, and troubleshooting for configuration enhancements.
  • Perform data analysis and validation by removing duplicates, errors, and outliers.
  • Build SQL queries to extract backend data supporting configuration and testing needs.
  • Conduct Fit/Gap Analysis for new client plans and provide configuration feedback.
  • Collaborate with leadership on the Configuration roadmap and automation initiatives.
  • Self-manage workload to meet SLAs and KPIs for project delivery.
  • Maintain strong working relationships with stakeholders across all levels of leadership.

Mandatory Skills (Must Have)

  • FACETS (Healthcare Claims & Benefit Configuration)
  • Healthcare claims understanding / benefit configuration
  • SQL / Database experience
  • Medicaid product configuration experience
  • Strong analytical and problem-solving skills
  • Ability to lead and represent cross-functional meetings
  • Business requirements gathering & documentation
  • Testing execution & claims validation

Tools & Technologies

  • FACETS (Claims testing & configuration)
  • Oracle SQL (Data extraction & validation)
  • Automation tools (Informatica-based, homegrown)
  • Windows OS

Desired / Preferred Qualifications

  • 4+ years of FACETS platform experience
  • Experience with Medical Plan Benefit Configuration
  • Provider Network & Agreement Configuration
  • Strong understanding of Medicare / Medicaid
  • Excellent communication and stakeholder management skills
  • Ability to learn quickly and operate independently in complex environments