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Claims Configuration Jobs in Clover, SC (NOW HIRING)

Judi Health

Lead, Medical Network Pricer

Charlotte, NC · On-site

$99K - $136K/yr

This role can then apply these terms to claims data, considering the application of coding ... Pricing Rules, Reimbursement Data & Platform Configuration * Interpret client reimbursement ...

Capital Rx

Lead, Medical Network Pricer

Charlotte, NC · On-site

$99K - $136K/yr

This role can then apply these terms to claims data, considering the application of coding ... Pricing Rules, Reimbursement Data & Platform Configuration * Interpret client reimbursement ...

Accenture

Epic Payer Platform Lead

Charlotte, NC · On-site

$106K - $138K/yr

Resolute PB or HB experience - helpful for troubleshooting claims data flows that span payer and provider systems * ADT/GrandCentral configuration experience - directly relevant to Wave 1 scope

Deloitte

Guidewire PolicyCenter Sr Developer

Charlotte, NC · On-site

$53.25 - $70.25/hr

Advanced degree in area of technical specialization CPCU, AIC, ARM Certification Guidewire Integration or Configuration certification 4 years experience with Guidewire Cloud Claims migration ...

Deloitte

Guidewire Architect

Charlotte, NC

$59.25 - $77.25/hr

Advanced degree in area of technical specialization CPCU, AIC, ARM Certification Guidewire Integration or Configuration certification 4 years experience with Guidewire Cloud Claims migration ...

Capital Rx

Medical Coding Specialist

Charlotte, NC · On-site

$70K - $85K/yr

Denver, CO; or New York, NY area) Position Overview We are seeking a highly motivated Medical Coding Specialist to support the accurate configuration, testing, and maintenance of medical claims ...

Judi Health

Medical Coding Specialist

Charlotte, NC · On-site

$70K - $85K/yr

Denver, CO; or New York, NY area) Position Overview We are seeking a highly motivated Medical Coding Specialist to support the accurate configuration, testing, and maintenance of medical claims ...

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All JobsClaims Configuration JobsClaims Configuration Jobs in Clover, SC

Claims Configuration information

See Clover, SC salary details

$30K

$75.4K

$119.2K

How much do claims configuration jobs pay per year?

As of Sep 1, 2026, the average yearly pay for claims configuration in Clover, SC is $75,374.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,300.00 and $90,100.00 per year, depending on experience, location, and employer.

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 Clover, SC?

For Claims Configuration jobs in Clover, SC, the most frequently searched job titles are:

Claims Configuration jobs near you

Principal, Provider Data Management

Judi Health

Charlotte, NC • On-site

Full-time

Posted 19 days ago

Job description

About Judi Health
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.
Location: Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area)
Position Summary:
The Principal, Provider Data Management is the enterprise subject-matter expert and senior steward for provider, network, roster, and provider contract data. This role ensures provider data is accurate, governed, compliant, and consistently propagated to claims, repricing, directories, portals, analytics, care navigation, vendors, and client-facing reporting. The Principal owns standards and controls for provider adds, deletes, terminations, demographic changes, network participation, contract attributes, effective dates, fee schedule references, product/tier applicability, and roster reconciliation.
This position operates at a senior individual-contributor level: leading governance design, resolving complex data issues, strengthening claims-pricing defensibility, mentoring operational teams, and driving sustainable improvements across provider data intake, maintenance, quality, audit readiness, and downstream consumption.
Position Responsibilities:
  • Lead enterprise provider-data governance for critical provider and contract fields, including NPI, TIN, taxonomy/specialty, locations, group/facility relationships, network status, effective/termination dates, product applicability, and contract references.
  • Own compliant processes for provider adds, deletes, changes, and terminations, including source documentation, approval controls, effective-date logic, exception handling, audit trail, and SLA oversight.
  • Manage and improve roster operations for contracted groups, facilities, ancillaries, direct contracts, COEs, high-performance networks, wrap networks, and other network arrangements.
  • Partner with Network Contracting, Product and Engineering teams and Third-Party vendors to translate contract terms, amendments, carve-outs, fee schedules, tiers, and reimbursement indicators into accurate provider data and pricing setup requirements.
  • Ensure accurate downstream propagation to claims, repricing, provider directories, member/provider portals, eligibility, care navigation, UM, analytics, stop-loss, client reporting, EDI/data feeds, and external vendors.
  • Design and run data-quality controls: completeness checks, duplicate detection, roster reconciliation, effective-date validation, contract-data alignment, exception reporting, and root-cause correction plans.
  • Serve as escalation point for high-impact issues involving claims pricing, network assignment, directory accuracy, access-to-care, provider payment, client implementation, or compliance exposure.
  • Maintain SOPs, data dictionaries, governance rules, change-control artifacts, intake templates, QA checklists, reconciliation standards, and management reporting.
  • Support audits, regulatory readiness, network adequacy/directory accuracy needs, NSA/balance-billing operations, and client commitments by producing defensible documentation and control evidence.
  • Mentor analysts/specialists, influence cross-functional operating practices, and lead continuous-improvement initiatives that increase data quality, speed, transparency, and accountability.

Required Qualifications:
  • Bachelor's degree in healthcare administration, business, information systems, analytics, or a related field
  • 7+ years of healthcare provider data, network operations, payer/TPA operations, claims configuration, provider relations, or healthcare data-governance experience.
  • Data stewardship, contract-data fluency, claims/network acumen, governance mindset, executive communication, root-cause problem solving, cross-functional leadership.
  • Advanced understanding of provider identifiers, provider hierarchies, roster management, contract data, network participation, effective dating, and downstream payer/TPA system impacts.
  • Demonstrated ability to govern provider adds/deletes/changes with strong controls, documentation, reconciliation, audit readiness, and issue-resolution discipline.
  • Strong knowledge of how provider data impacts claims pricing, repricing, member liability, provider directories, network access, client implementations, reporting, and vendor integrations.
  • Advanced Excel/data-analysis skills and comfort working with large datasets, exception reports, data feeds, workflow tools, and operational dashboards.
  • Ability to influence senior stakeholders across Network Contracting, Claims, IT, EDI/Data Engineering, Compliance, Legal, Provider Relations, Analytics, Client Implementation, and vendors.

Preferred Qualifications:
  • Experience in a medical TPA, PPO/network vendor, self-funded employer/ASO, captive, direct-contracting, repricing, or health plan environment.
  • Experience with contract loading, fee schedules, claims-pricing logic, tiered networks, COEs, direct primary care, wrap networks, value-based arrangements, or provider directory/network adequacy processes.
  • Working knowledge of SQL, data warehouses, EDI/file feeds, provider master data tools, claims platforms, CRM/workflow platforms, or data visualization/reporting tools.
  • Experience building governance frameworks, data dictionaries, operating metrics, QA controls, and audit-ready documentation for provider/network data.
  • Relevant training/certification in healthcare operations, data governance, project management, Lean/Six Sigma, compliance, or analytics.

New York, NY Salary Range
$144,800-$181,000 USD
Denver, CO Salary Range
$132,800-$166,000 USD
Charlotte, NC Salary Range
$120,800-$151,000 USD
All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.

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