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Claims Configuration Jobs in Texas (NOW HIRING)

SmithRx

Senior Benefits Configuration Tester

Plano, TX · On-site

As a Senior Benefits Configuration Tester, you have a substantial understanding of benefit design ... SmithRx claims adjudication systems and upstream/downstream processes. * Handle Advanced Logic ...

Sonic Healthcare USA

RCM Data Coordinator

Dallas, TX · On-site

Research returned mail for claims address to correct accordingly and update configurations. * Identify and/or resolve pre-processing system errors and claim edits requiring system configuration ...

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All JobsClaims Configuration JobsClaims Configuration Jobs in Texas

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?

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:

Claims Configuration jobs near you

Lead EHR Clinical Apps Analyst (Epic Hospital Billing Claims), Remote - ITS-Clin Revenue Cycle

UTMB Health

Galveston, TX • On-site, Remote

Full-time

Posted 20 days ago

UTMB Health rating

7.3

Company rating: 7.3 out of 10

Based on 168 frontline employees who took The Breakroom Quiz

270th of 887 rated healthcare providers

Job description

Minimum Qualifications:
Bachelor's degree in a related field and five years of related experience. Must possess sufficient educational background and/or experience to conduct clinical applications analysis and/or programming of complex systems, analysis of clinical workflows, and system adoption strategies. An equivalent combination of education and experience relevant to the role may be considered for this position.
Preferred Qualifications:
Epic Hospital Billing Claims Accreditation/ Certification.
Job Summary:
This position is responsible for the design, configuration, implementation, optimization, maintenance, and support of complex clinical systems to improve in compliance with all applicable regulations and organizational policies. Clinical applications include any software application used in support of the clinical enterprise including patient registration, patient billing, clinical documentation utilized in the ambulatory and inpatient settings, as well as applications for specific medical specialties such as, but not limited to, Radiology, Pathology, Oncology, Transplant, and Cardiology. Other responsibilities include providing advanced analysis and documentation, formulating logical statements of business and management problems to develop requirements for configuration of clinical applications, and providing solutions to complex problems. This role requires an understanding of the assigned system applications, functions, and features end-users would experience. Has full technical knowledge of all phases of clinical applications programming.
Job Duties:
The Lead HB Epic Claims Analyst serves as the primary expert for Epic Hospital Billing (HB) claims workflows, projects, and system configuration. The analyst partners closely with operational teams to maintain a stable, compliant, and optimized Epic claims environment.
Key Responsibilities:
  • Lead configuration, testing, and maintenance of Epic HB claims and remittance workflows.
  • Troubleshoot complex claims issues and serve as the main escalation point for operational teams.
  • Lead claims-related projects, enhancements, and optimization efforts.

Knowledge/Skills/Abilities:
3-5 years of Epic Hospital Billing Claims Remittance Experience.
1. EHR Clinical Application Analyst - Least Experienced
2. EHR Clinical Application Analyst, Senior
3. EHR Clinical Application Analyst, Lead ***(this position)
4. EHR Clinical Solution Analyst
5. EHR Clinical Solution Specialist - Most Experienced
Salary Range:
Actual salary commensurate with experience.
Work Schedule:
Remote position. 8 am to 5 pm, and as needed on occasion.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

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