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Claims Configuration Jobs in Silver Spring, MD (NOW HIRING)

CareFirst

Payment Policy Analyst (Remote)

Baltimore, MD · Remote

Ensures dissemination of payment policies and procedures to implementation teams (e.g., claims, configuration, provider operations) and other appropriate departments. Ensures maintenance and accuracy ...

GEICO

Senior Claims Product Tester

Bethesda, MD · On-site

Test claims system enhancements, configuration changes, and new product features prior to production release. * Identify, document, track, and communicate defects, missed requirements, and business ...

Geico

Senior Claims Product Tester

Bethesda, MD

Test claims system enhancements, configuration changes, and new product features prior to production release. * Identify, document, track, and communicate defects, missed requirements, and business ...

Collabera

Sr. Level Facets SME

Baltimore, MD · On-site

Knowledge of the claims and product data models is required * Heavy experience on the product side * Configuration experience Responsibilities: * Analysis of new and/or changed Plan benefit ...

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

Baltimore, MD

$62.50 - $82.50/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

Rosslyn, VA

$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

Mclean, VA · On-site

$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 ...

Deloitte

Consultant - Guidewire Developer

Rosslyn, VA · On-site

Guidewire Integration or Configuration certification * 1 year experience with Guidewire Cloud Claims migration * Experience delivering via an Agile/Scrum methodology * A strong Java, Gosu (Guidewire ...

Deloitte

Consultant - Guidewire Developer

Mclean, VA · On-site

Guidewire Integration or Configuration certification * 1 year experience with Guidewire Cloud Claims migration * Experience delivering via an Agile/Scrum methodology * A strong Java, Gosu (Guidewire ...

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Showing results 1-20

All JobsClaims Configuration JobsClaims Configuration Jobs in Silver Spring, MD

Claims Configuration information

See Silver Spring, MD salary details

$36.2K

$90.8K

$143.7K

How much do claims configuration jobs pay per year?

As of Jul 28, 2026, the average yearly pay for claims configuration in Silver Spring, MD is $90,829.00, according to ZipRecruiter salary data. Most workers in this role earn between $70,300.00 and $108,500.00 per year, depending on experience, location, and employer.

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 Silver Spring, MD? For Claims Configuration jobs in Silver Spring, MD, the most frequently searched job titles are:
What job categories do people searching Claims Configuration jobs in Silver Spring, MD look for? The top searched job categories for Claims Configuration jobs in Silver Spring, MD are:
What cities near Silver Spring, MD are hiring for Claims Configuration jobs? Cities near Silver Spring, MD with the most Claims Configuration job openings:
Claims Configuration jobs near you
Senior HRP Benefits Configuration Consultant

Senior HRP Benefits Configuration Consultant

Educology Solutions

Washington, DC • Remote

Full-time

Medical

Posted 3 days ago

Job description

Senior HealthRules Payor (HRP) Benefits Configuration Consultant to support multiple healthcare payer implementation and optimization initiatives. The ideal candidate will possess deep expertise in HealthRules Payor Benefits Configuration, Medicare and Medicaid benefit design, claims adjudication, pricing, testing, and production support.

This individual will work closely with Business Operations, Product, Claims, Configuration, IT, QA, and HealthEdge to configure and implement complex healthcare benefit plans while ensuring regulatory compliance and high auto-adjudication performance.

The successful candidate is a self-driven consultant capable of translating business requirements into HealthRules Payor configuration while supporting implementation, testing, and production stabilization. The start date will be ASAP and end Jan 30th 2027 with potetial extensions. All work will be remote, with the possibility of being on site during Go Live (2 weeks).

DUTIES & RESPONSIBILITIESHealthRules Payor Benefits Configuration
  • Configure and maintain medical benefit plans within HealthRules Payor (HRP)
  • Configure: oBenefit Packages
  • Products oPlan Designs
  • Cost Shares oDeductibles
  • Copays oCoinsurance
  • Accumulators oLimits
  • Exclusions
  • Configure pricing and benefit logic to support accurate claims adjudication.
  • Support benefit changes resulting from CMS and State regulatory updates.
    • Business Analysis
  • Collaborate with Business and IT stakeholders to understand benefit requirements.
  • Translate business requirements into technical configuration specifications.
  • Identify configuration gaps and recommend solutions.
  • Participate in requirements gathering sessions and design reviews.
    • Testing
  • Develop test scenarios.
  • Execute configuration validation.
  • Support SIT, UAT, EndtoEnd, and Production Validation.
  • Validate benefit configuration before deployment.
  • Support defect triage and issue resolution.
    • Production Support
  • Investigate production incidents.
  • Perform root cause analysis.
  • Coordinate configuration fixes.
  • Support implementation weekends and GoLive activities.
  • Participate in Command Center activities during stabilization.
    • QUALIFICATIONS
  • 7+ years Healthcare Payer experience.
  • 5+ years HealthRules Payor (HRP) Configuration experience.
  • Strong expertise configuring: oMedical Benefits
  • Products oPlans
  • Pricing oCost Sharing
  • Experience with: oMedicare Advantage
  • Medicaid oDual Eligible (D-SNP)
  • Commercial Health Plans
  • Strong understanding of: oClaims adjudication
  • Benefit administration oCMS regulations
  • Benefit interpretation
  • Experience supporting HRP implementations or migrations.
  • Strong analytical and troubleshooting skills.
  • Excellent communication skills.
  • Ability to work directly with executive leadership, business users, and technical teams.
    • PREFERRED QUALIFICATIONSCandidates with experience in:
  • Medicare Advantage implementation
  • Medicaid implementation
  • DSNP configuration
  • Benefit migrations
  • Health plan system conversions
  • Claims optimization
  • Production stabilization
  • GoLive Command Centers
  • CMS Annual Benefit Updates
    • Soft Skills
  • Strong clientfacing communication
  • Ability to translate business needs into technical solutions
  • Excellent documentation skills
  • Strong problemsolving ability
  • Organized and detailoriented
  • Ability to manage multiple priorities
  • Collaborative leadership and Peer review

Apply