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Claims Configuration Jobs in Virginia (NOW HIRING)

Photon

QNXT Benefit Configuration SME - VA

Norfolk, VA · On-site

QNXT Benefit Configuration SMEs with emphasis on commercial plans and Member, Claims, Provider, Sponsor, Benefit modules and related reference Tables. Scope of the Need : * The resources will support ...

Photon

QNXT Benefit Configuration SME - VA

Norfolk, VA · On-site

QNXT Benefit Configuration SMEs with emphasis on commercial plans and Member, Claims, Provider, Sponsor, Benefit modules and related reference Tables. Scope of the Need : * The resources will support ...

Deloitte

Guidewire Architect

Rosslyn, VA · On-site

$71.75 - $94.50/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

Arlington, VA · On-site

$72.50 - $95.50/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

Mclean, VA

$63.75 - $84/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 ...

Imh

... Claims Administration, or Charge Router. The senior analyst is responsible for providing advanced technical support, configuration, integration, and maintenance for various healthcare applications ...

1 point system

Manual Tester

Richmond, VA · On-site

Support FAS upgrades, interface enhancements, configuration changes, and system security improvements. * Coordinate cross module alignment to ensure changes in Member, Claims, or Finance workflows do ...

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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?

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

QNXT Benefit Configuration SME - VA

Photon

Norfolk, VA • On-site

Other

Re-posted 27 days ago

Job description

QNXT Benefit Configuration SMEs with emphasis on commercial plans and Member, Claims, Provider, Sponsor, Benefit modules and related reference Tables.

 

Scope of the Need:

  • The resources will support Benefit Configuration, data formatting, validation, unit testing, and error remediation.
  • The Benefit Configuration Analyst SME would be collaborating with stakeholders to gather, assess, interpret, and design/document Benefit configuration needs and coverage requirements.  
  • Analysts must lead communications and facilitation efforts to present the documented findings and results from an analytical engagement.
  • The analysts must have the ability to independently analyze or mine data, draw sound conclusions, and is able to interpret detail plan benefit summaries
  • Analysts must diligently follow written instructions, oral instructions, and policy.

Experience Necessary: 

  • 3-5 Years of QNXT Benefit Configuration Implementation and Support Experience (Design, configuration, front/back-end load configuration, resolution/update)
    • Independently design, configure and build benefit plans and various benefit components in QNXT
    • Expertise in setting up and maintaining benefit plan hierarchies, including base plans, riders, and their attributes. This includes understanding the financial impact of benefit configurations on plan costs and premiums.
  • Deep knowledge of Claims Processing Lifecycle - Including the upstream/downstream processes that impact claims payment
  • Independently research claims issues to determine benefit configuration gaps, update configuration as applicable.
  • Exposure and demonstrated ability to create / maintain UM Authorization Templates 
  • 3-5 Years experience of a demonstrated ability to independently create intermediate SQL queries - above and beyond basic.
  • Ability to rapidly interpret and understand current data schemas that are new an unfamiliar
  • Proven ability to operate in complex projects related to benefit configuration, including the ability to lead cross-functional teams and manage timelines, resources, and deliverables effectively.
  • Demonstrated experience in identifying, diagnosing, and resolving complex issues related to benefit configuration in QNXT, including performance tuning and system optimization.

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