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Claims Configuration Jobs in Ohio (NOW HIRING)

CareSource

Provider Contracting Analyst II

Dayton, OH · On-site

$72K - $115K/yr

Perform contract repricing analyses using claims data to assess financial impact of proposed rate ... Collaborate with configuration, actuarial, data engineering, and clinical teams to ensure alignment ...

ClinDCast LLC

Healthcare System Analyst

Mason, OH · On-site

The candidate should possess strong knowledge of healthcare claims, enrollment, provider, and member workflows along with hands-on experience in Facets configuration/support and modern web ...

Ztek Consulting INC

Senior Content Developer

Cleveland, OH · On-site

$119K - $124K/yr

... configuration debugging technical leadership environment management deployment support and cross functional collaboration across Duck Creek Policy Billing and Claims Key Responsibilities * Design ...

Accenture

Epic Payer Platform Lead

Cleveland, OH

$105K - $137K/yr

Resolute PB or HB experience - helpful for troubleshooting claims data flows that span payer and provider systems * ADT/GrandCentral configuration experience - directly relevant to Wave 1 scope

New

Accenture

Epic Payer Platform Lead

Columbus, OH · On-site

$105K - $137K/yr

Resolute PB or HB experience - helpful for troubleshooting claims data flows that span payer and provider systems * ADT/GrandCentral configuration experience - directly relevant to Wave 1 scope

New

Accenture

Epic Payer Platform Lead

Hartford, OH · On-site

$98K - $127K/yr

Resolute PB or HB experience - helpful for troubleshooting claims data flows that span payer and provider systems * ADT/GrandCentral configuration experience - directly relevant to Wave 1 scope

New

Accenture

Epic Payer Platform Lead

Cincinnati, OH · On-site

$104K - $136K/yr

Resolute PB or HB experience - helpful for troubleshooting claims data flows that span payer and provider systems * ADT/GrandCentral configuration experience - directly relevant to Wave 1 scope

New

Deloitte

Guidewire Architect

Columbus, OH · On-site

$58.75 - $76.25/hr

Advanced degree in area of technical specialization CPCU, AIC, ARM Certification Guidewire Integration or Configuration certification 4 years experience with Guidewire Cloud Claims migration ...

Deloitte

Guidewire PolicyCenter Sr Developer

Cleveland, OH · On-site

$52.75 - $69.75/hr

Advanced degree in area of technical specialization CPCU, AIC, ARM Certification Guidewire Integration or Configuration certification 4 years experience with Guidewire Cloud Claims migration ...

Deloitte

Guidewire PolicyCenter Sr Developer

Columbus, OH · On-site

$52.75 - $69.50/hr

Advanced degree in area of technical specialization CPCU, AIC, ARM Certification Guidewire Integration or Configuration certification 4 years experience with Guidewire Cloud Claims migration ...

Deloitte

Guidewire PolicyCenter Sr Developer

Cincinnati, OH · On-site

$52.25 - $69/hr

Advanced degree in area of technical specialization CPCU, AIC, ARM Certification Guidewire Integration or Configuration certification 4 years experience with Guidewire Cloud Claims migration ...

Deloitte

Guidewire Architect

Cleveland, OH · On-site

$59 - $76.50/hr

Advanced degree in area of technical specialization CPCU, AIC, ARM Certification Guidewire Integration or Configuration certification 4 years experience with Guidewire Cloud Claims migration ...

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Claims Configuration information

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?

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 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 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
Infographic showing various Claims Configuration job openings in Ohio as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Provider Contracting Analyst II

CareSource

Dayton, OH • On-site

$72K - $115K/yr

Full-time

Re-posted yesterday

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

207th of 311 rated insurance

Job description

Job Summary:
The Provider Contracting Analyst II supports the development, validation, and optimization of provider reimbursement strategies through advanced data analysis, financial modeling, and AI-enabled analytic tools. This role is responsible for evaluating provider payment methodologies, conducting contract repricing analyses, and delivering actionable insights to support contracting decisions. They apply modern analytics techniques-including automation and artificial intelligence-to enhance accuracy, scalability, and efficiency in reimbursement modeling and reporting.
Essential Functions:
  • Develop and maintain provider reimbursement models across multiple payment structures, including fee schedules, percent-of-Medicare, bundled payments, and case rate arrangements.
  • Perform contract repricing analyses using claims data to assess financial impact of proposed rate and contract changes.
  • Analyze key financial metrics, including billed charges, allowed amounts, units, and utilization trends, to identify cost drivers and performance variation.
  • Support benchmarking of provider reimbursement rates against applicable Medicare, Medicaid, and commercial benchmarks.
  • Assist in evaluating pricing approaches for unlisted or miscellaneous CPT/HCPCS codes by identifying comparable services.
  • Utilize SQL, Python, and business intelligence tools to analyze large, complex healthcare datasets.
  • Leverage automation and AI-assisted tools to improve efficiency in data processing, variance identification, and reporting.
  • Apply advanced analytical techniques to identify anomalies, outliers, and opportunities for cost containment.
  • Perform scenario modeling to evaluate the financial and operational implications of alternative reimbursement structures.
  • Partner with contracting, finance, and operational teams to support rate development and network strategy initiatives.
  • Provide analytical support for reimbursement assessments.
  • Collaborate with configuration, actuarial, data engineering, and clinical teams to ensure alignment between contract terms, system configuration, and analytical outputs.
  • Participate in requirements gathering, data validation, and issue resolution activities.
  • Support implementation and refinement of reimbursement logic within claims processing systems.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in Healthcare Administration, Data Analytics, Finance, Economics or related field required
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Two (2) years of experience in healthcare reimbursement, provider contracting or claims data analysis required
  • Experience working with healthcare claims data and reimbursement methodologies required
  • Experience with data analytics tools, automation, or AI enabled technologies preferred

Competencies, Knowledge and Skills:
  • Understanding of healthcare reimbursement methodologies, including Medicare, Medicaid, and commercial payment models
  • Familiarity with CPT/HCPCS coding, DRGs, APCs, and related billing constructs
  • Knowledge of provider contracting structures and pricing strategies
  • Proficiency in SQL for data extraction, transformation, and analysis
  • Working knowledge of Python or similar languages for data analysis and automation
  • Familiarity with business intelligence tools such as Power BI or Tableau
  • Familiarity with analytics automation and AI-assisted tools
  • Strong analytical and quantitative reasoning skills
  • Ability to interpret complex data and translate it into actionable insights
  • High attention to detail with a focus on accuracy and validation
  • Ability to effectively communicate technical concepts to both technical and non-technical audiences
  • Strong written and verbal communication skills
  • Ability to work independently and collaboratively in a team environment
  • Ability to manage multiple priorities in a fast-paced environment
  • Strong time management and problem-solving skills

Licensure and Certification:
  • None

Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$72,200.00 - $115,500.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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Brand=CareSource

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