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Claims Configuration Jobs in Wisconsin (NOW HIRING)

Oversees design, configuration, testing, and support for EDI transactions including - ANSI X12 (837 ... Supports claims processing, encounter reporting, and data platform operations. * Leads platform ...

WI · On-site

$80 - $100/hr

... configuration control processes. * Support electrical testing activities including: * Routine ... Collaborate with Quality teams to investigate warranty claims and customer concerns. * Interface ...

We're pushing boundaries with innovative AI solutions that simplify and enhance the claims and ... configuration, price, and mileage. Additionally, this role completes audits of automotive repair ...

Data Center Supervisor I

Madison, WI · On-site

$40K - $115K/yr

Monitors, tracks and manages the configuration, accessing delivery process of software coding for the lottery--including games, parameters, odds and claims. * Verifies and analyzes the accuracy and ...

Monitors, tracks and manages the configuration, accessing delivery process of software coding for the lottery--including games, parameters, odds and claims. * Verifies and analyzes the accuracy and ...

WI · On-site

$90 - $120/hr

... maintaining configuration control processes. Support electrical testing activities including ... Collaborate with Quality teams to investigate warranty claims and customer concerns. Interface with ...

Monitors, tracks and manages the configuration, accessing delivery process of software coding for the lottery--including games, parameters, odds and claims. * Verifies and analyzes the accuracy and ...

Showing results 41-56

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 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:

Manager, EDI & Platform Engineering

Quartz

Madison, WI • Remote

$107K - $134K/yr

Full-time

Posted 19 days ago


Job description

Quartz Health Solutions is seeking a dynamic Manager, EDI & Platform Engineering to lead a high-performing team responsible for enterprise healthcare data exchange and platform operations. This role will blend technical leadership, people management, and strategic execution to ensure scalable, reliable, and compliant healthcare data systems. This position will oversee EDI (Electronic Data Interchange) platforms, support core healthcare applications, and drive innovation across operational and data platforms.

Key Skills the Manager, EDI & Platform Engineer will use on a regular basis:

  • Knowledge of Healthcare EDI & data exchange (X12 standards)
  • Platform engineering and system integration
  • Leadership, coaching, and team development
  • Vendor and stakeholder management
  • Problem-solving and strategic thinking
  • Communication and collaboration skills

Benefits:

  • Key leadership role in shaping technical direction, improving operational performance, and enabling exceptional customer experiences.
  • Starting salary based upon skills and experience: $107,500 - $134,400 plus robust benefits package

  • Leadership & Team Management
    • Selects, develops, motivates, trains, and retains a team of engineers and technical specialists.
    • Manages performance, career growth, and employee engagement.
    • Oversees vendor partnerships and third-party technology providers.
    • Ensures delivery against service level agreements (SLAs) and operational targets.
  • Technical & Operational Excellence
    • Oversees design, configuration, testing, and support for EDI transactions including - ANSI X12 (837, 835, 270/271, 276/277, 278, 820, 277CA).
    • Manages EDI transformations (X12, flat file) integrations, and interfaces.
    • Supports claims processing, encounter reporting, and data platform operations.
    • Leads platform reliability, scalability, and continuous improvement initiatives.
  • Strategy & Innovation
    • Drives adoption of new technologies and process improvements.
    • Influences business and technical strategy aligned with organizational goals.
    • Leads cross-functional initiatives that impact multiple business units.
    • Identifies risks, dependencies, and opportunities for optimization.
  • Project & Stakeholder Leadership
    • Leads complex, highly-visible initiatives from planning through execution.
    • Acts as a trusted advisor and subject matter expert on healthcare platforms.
    • Support Epic Tapestry release management activities and governance

  • Bachelor's degree in management information systems, business management, or related field with 5+ years of experience in healthcare applications
    • Or associate degree in management information systems, business management, or related field with 8+ years of experience in healthcare applications
    • Or high school equivalency with 11+ years of experience in healthcare applications
  • Experience leading third party vendors implementing new technology
  • Demonstrated knowledge of healthcare EDI transactions and platform operations
  • In-depth understanding of healthcare concepts, theories, and principles
  • Experience delivering large-scale technical initiatives
  • Ability to problem solve and apply analytic thinking skills
  • Good knowledge of computer software applications
  • Works well under pressure and adaptable to change; manages multiple projects simultaneously and completes timely
  • Good interactive skills with internal and external customers including vendors and contractors
  • Six Sigma Yellow Belt certification or ability to obtain within 6 months of position start date
  • Certification or ability to obtain certification in applicable Epic Platforms (Tapestry)

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.