Claims Finance Manager
Frisco, TX · On-site
The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration, Revenue Operations, Product, and Executive Leadership to evaluate the financial impact of claims decisions ...
Claims Finance Manager
Frisco, TX · On-site
The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration, Revenue Operations, Product, and Executive Leadership to evaluate the financial impact of claims decisions ...
The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration, Revenue Operations, Product, and Executive Leadership to evaluate the financial impact of claims decisions ...
The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration, Revenue Operations, Product, and Executive Leadership to evaluate the financial impact of claims decisions ...
The ideal candidate will possess in-depth knowledge of QNXT benefits configuration, along with a strong background in both commercial and government benefit claims. This role is critical for ensuring ...
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The ideal candidate will possess in-depth knowledge of QNXT benefits configuration, along with a strong background in both commercial and government benefit claims. This role is critical for ensuring ...
Summary: Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization ...
Summary: Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization ...
Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization Management, as ...
Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization Management, as ...
Manager System Configuration
Houston, TX · On-site
$122K - $156K/yr
Reviews ticket/request queues daily to ensure that all state and federal claims processing ... Lead the configuration/solutions development team in the design, development, deployment and ...
Manager System Configuration
Houston, TX · On-site
$122K - $156K/yr
Reviews ticket/request queues daily to ensure that all state and federal claims processing ... Lead the configuration/solutions development team in the design, development, deployment and ...
Claims Representative
Dallas, TX · Remote
$18 - $32/hr
Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider) * Resolve or address ...
Claims Representative
Dallas, TX · Remote
$18 - $32/hr
Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider) * Resolve or address ...
Claims Examiner Senior Irving TX 75039 - Onsite Shift: 8 AM - 5 PM Monday-Friday Duration: 13 ... This role works in conjunction with Business Configuration, Network Management, Provider Data ...
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Claims Examiner Senior Irving TX 75039 - Onsite Shift: 8 AM - 5 PM Monday-Friday Duration: 13 ... This role works in conjunction with Business Configuration, Network Management, Provider Data ...
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Quick apply
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years' HMO/PPO claims experience required. Amisys claims processing system experience ...
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years' HMO/PPO claims experience required. Amisys claims processing system experience ...
Claims Analyst
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years' HMO/PPO claims experience required. Amisys claims processing system experience ...
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years' HMO/PPO claims experience required. Amisys claims processing system experience ...
Claims Analyst
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years' HMO/PPO claims experience required. Amisys claims processing system experience ...
Claims Analyst
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years' HMO/PPO claims experience required. Amisys claims processing system experience ...
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Analyst
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Claims Configuration information
What is the difference between Claims Configuration vs Claims Processing Specialist?
| Aspect | Claims Configuration | Claims Processing Specialist |
|---|---|---|
| Primary Role | Setting up and customizing claims systems and workflows | Reviewing, adjudicating, and processing individual insurance claims |
| Required Skills | Technical knowledge of claims systems, data management | Attention to detail, knowledge of claims policies, customer service |
| Work Environment | Typically in IT or claims system teams within insurance companies | In claims departments, interacting directly with claimants and providers |
| Certifications | Claims system certifications, insurance knowledge | Insurance 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?
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 Texas?
For Claims Configuration jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Claims Configuration jobs in Texas look for?
The top searched job categories for Claims Configuration jobs in Texas are:
What cities in Texas are hiring for Claims Configuration jobs?
Cities in Texas with the most Claims Configuration job openings:
Full-time
Medical, Dental, Vision
Posted 21 days ago
Careington rating
8.1
Based on 8 frontline employees who took The Breakroom Quiz
Job description
Careington International is looking to add a Claims Finance Manager to our TEAM. This position will be worked onsite at 7400 Gaylord Pkwy in Frisco, TX.
The Claims Finance Manager serves as the critical link between Claims Operations and Corporate Finance, ensuring financial accountability, payment accuracy, and operational efficiency throughout the claims adjudication lifecycle. This role translates claims activity into financial insights by analyzing claim costs, reimbursement trends, adjudication outcomes, reserve impacts, and operational performance.
The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration, Revenue Operations, Product, and Executive Leadership to evaluate the financial impact of claims decisions, identify opportunities to reduce payment leakage, improve adjudication accuracy, and support strategic business objectives. This position plays a key role in balancing financial stewardship, customer obligations, and operational excellence.
EXPECTED WORK AND PERFORMANCE:
Claims Finance & Financial Oversight
Claims Adjudication Analysis
Financial Planning & Reporting
Business Partnership & Strategy
Risk Management & Compliance
People Management & Development
QUALIFICATIONS:
Required
Preferred
SKILLS:
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
The Claims Finance Manager serves as the critical link between Claims Operations and Corporate Finance, ensuring financial accountability, payment accuracy, and operational efficiency throughout the claims adjudication lifecycle. This role translates claims activity into financial insights by analyzing claim costs, reimbursement trends, adjudication outcomes, reserve impacts, and operational performance.
The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration, Revenue Operations, Product, and Executive Leadership to evaluate the financial impact of claims decisions, identify opportunities to reduce payment leakage, improve adjudication accuracy, and support strategic business objectives. This position plays a key role in balancing financial stewardship, customer obligations, and operational excellence.
EXPECTED WORK AND PERFORMANCE:
Claims Finance & Financial Oversight
- Serve as the primary liaison between Claims Operations and Accounting & Finance, bridging claims adjudication activities with corporate financial objectives
- Analyze claims payment activity, funding, payment activity, adjudication outcomes, and reimbursement trends to ensure financial accuracy and integrity
- Monitor claim costs, payment variances, financial leakage, recoveries, and adjustments
- Evaluate the financial impact of claim processing decisions, benefit configurations, and reimbursement methodologies
- Support the development of financial controls that ensure accurate and compliant claim payments
- Manage the claims operational financial tasks such as:
- Client Request for Funds/Credits
- Provider Claim Payment Cycle Processing
- Provider Recoupments
- Own the reconciliation of claims funding, payment disbursements, credits, recoupments, refunds, and related general ledger activity
- Research and resolve variances, aged reconciling items, unapplied funds, outstanding payments, and funding shortfalls in partnership with Claims and Accounting & Finance
Claims Adjudication Analysis
- Review adjudicated claims to identify trends, anomalies, and opportunities for process improvement
- Partner with Claims and Configuration teams to investigate payment discrepancies and adjudication errors
- Analyze denial, appeal, adjustment, and rework trends to identify operational and financial risks
- Monitor first-pass adjudication rates, auto-adjudication performance, and payment accuracy metrics
- Provide recommendations to improve claims accuracy while reducing administrative costs
Financial Planning & Reporting
- Develop financial reports, dashboards, and analyses related to claims operations
- Support budgeting, forecasting, and financial planning activities related to claims volume, costs, and operational expenses
- Prepare executive-level reporting on claims financial performance, trends, risks, and opportunities
- Translate operational claims data into meaningful financial insights for leadership decision-making
Business Partnership & Strategy
- Collaborate with Claims Leadership, Product, Technology, Client Services, and Finance teams to support organizational goals
- Assess the financial impact of system enhancements, configuration changes, new client implementations, and process improvements
- Support strategic initiatives focused on reducing claim costs, improving adjudication efficiency, and increasing profitability
- Provide financial guidance during audits, client reviews, and operational assessments
Risk Management & Compliance
- Ensure claims-related financial processes comply with contractual, regulatory, and organizational requirements
- Support internal and external audits related to claims payments and financial controls
- Identify financial risks associated with claims processing and recommend mitigation strategies
- Maintain oversight of payment integrity and recovery initiatives
People Management & Development
- Effectively manage, coach and development members of the team.
QUALIFICATIONS:
Required
- Bachelor's degree in Finance, Accounting, Business Administration, Healthcare Administration, or related field
- 5+ years of experience in finance, claims operations, healthcare administration, insurance, or revenue cycle management
- Strong understanding of claims adjudication, reimbursement methodologies, and payment integrity principles
- Experience performing financial analysis and reporting in a claims-driven environment
- Advanced Excel and data analysis skills
Preferred
- Experience within healthcare claims administration, dental benefits, vision benefits, TPAs, or insurance organizations.
- Working knowledge of financial procedures like escheatment and 1099 processing.
- MBA, CPA, CMA, or similar professional certification.
- Experience with claims adjudication platforms, payment integrity tools, and business intelligence reporting systems.
SKILLS:
- Strong understanding of both claims operations and financial management principles.
- Ability to connect operational claim outcomes with financial performance.
- Expertise in claims payment analysis, reimbursement methodologies, and cost containment strategies.
- Strong analytical and problem-solving skills.
- Ability to communicate complex financial concepts to operational leaders.
- Experience leading cross-functional initiatives and process improvement efforts.
- Excellent presentation, reporting, and stakeholder management skills.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
What Careington employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Careington International
Sourced by ZipRecruiter
Industry
Fitness and sports centers
Company size
51 - 200 Employees
Headquarters location
Frisco, TX, US
Year founded
1979