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Claims Configuration Jobs in Wisconsin (NOW HIRING)

Dentaquest

Workflow Data Analyst

Grafton, WI · On-site

Manages and maintains configuration data required for core claims processing system settings. * Troubleshoots, researches, and corrects assigned tickets/issues that may be related to system ...

Dentaquest

Workflow Data Analyst

Grafton, WI · On-site

Manages and maintains configuration data required for core claims processing system settings. * Troubleshoots, researches, and corrects assigned tickets/issues that may be related to system ...

Imedica

Director, Claims Operations

Madison, WI

$113K - $194K/yr

Partner cross-functionally (Payment Integrity, Customer Service, EDI, Configuration, Finance, IT, Compliance/SIU, Markets) to ensure accurate, timely claims outcomes and alignment across a matrixed ...

Navitus Health Solutions, LLC

$142K - $177K/yr

Provide strategic guidance on contract interpretation to support claims configuration, pricing application, and network governance. * Support enterprise initiatives related to network strategy ...

Itron, Inc

This role focuses on configuration and technical enablement required to bring customers live ... claims mapping, and identity architecture * Support enterprise security readiness reviews and ...

Itron, Inc

This role focuses on configuration and technical enablement required to bring customers live ... claims mapping, and identity architecture * Support enterprise security readiness reviews and ...

Mercyhealth

Internal Auditor

Janesville, WI

$58K - $94K/yr

... claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration. * Research claim processing issues and ...

Mercyhealth

Internal Auditor

Janesville, WI · On-site

$58K - $94K/yr

... claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration. * Research claim processing issues and ...

Quartz

Pharmacy Specialist

Madison, WI

$20.72 - $25.91/hr

Translate approved policies into systemready rules and decision trees for prior authorization and claims platforms, partnering with IT/Benefit Configuration/PBM resources to test and validate ...

Quartz

Pharmacy Specialist

Madison, WI · On-site

$20.72 - $25.91/hr

Translate approved policies into system-ready rules and decision trees for prior authorization and claims platforms, partnering with IT/Benefit Configuration/PBM resources to test and validate ...

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

Workflow Data Analyst

Dentaquest

Grafton, WI • On-site

Other

Re-posted 29 days ago

DentaQuest rating

7.1

Company rating: 7.1 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

228th of 281 rated insurance

Job description

Job Description

Under moderate supervision, the Workflow Systems Configuration Analyst I is responsible for working with business teams in defining and maintaining Windward Workflow configuration, including queues, reject codes, reject actions and pends, key words, suspend reasons, RFS codes, holds, queue security, and other configuration data that drives claims processing.  The Workflow Systems Configuration Analyst I is also responsible for defining and maintaining system reference, global system settings and building bulk data loads for other configuration data such as fees and client data, and ensuring proper use of core systems functionality in alignment with corporate goals.  Consults with operations, business implementation and IT development teams to understand the impact of functional changes to systems configuration, assists in developing system solutions, and debugs system issues. The Workflow Systems Configuration Analyst I understands business problems and/or requirements, recommends solutions to meet/solve those requirements using existing system functionality and provides excellent support to UM, Claims Operations, Underwriting, and Dental Management and other operational departments to enable them to best serve our customers. 

 

JOB RESPONSIBILITIES:

 

  • Works with UM, Claims Operations, Underwriting, and Dental Management and/or other operational teams in the implementation of new business and other enterprise projects involving the Workflow configuration of our dental systems, including aspects of client configuration.
  • Manages and maintains configuration data required for core claims processing system settings.  
  • Troubleshoots, researches, and corrects assigned tickets/issues that may be related to system configuration, in order to determine root causes including process and validation gaps, training, system defects, etc.
  • Translates client requirements into solutions using core systems configuration settings.
  • Works with IT systems analysts and developers in order to help solve system defects, providing subject matter expert input into use cases, as well as supporting testing of new system functionality or hotfixes related to Workflow and Client systems configuration.
  • Understand, specify, test, and approve relational database scripts designed by configuration development resources.
  • Manage and specify user interface requirements for effective configuration management.
  • Ensures accuracy of system configuration pre and post implementation
  • Ability to define and generate test plans for new configuration settings and systems coding
  • Supports total quality and continuous improvement by recommending standards, procedures and process improvements.
  • Working with Client Configuration, customers, vendors and management, analyzes requirements against current system functionality, develops and deploys proposed solutions to business requirements of moderate complexity.
  • Works closely with internal departments and operations management to streamline systems processes.
  • Maps coding and temporary/pre-production data to build SQL scripts and relationship statements and maintain configuration data.
  • Consults on system/technical aspects of new business implementations and core system enhancements, as they relate to Client configuration as assigned.
  • Adhere to DentaQuest business processes.
  • Other duties as assigned.

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