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Claims Configuration information

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$35K

$87.9K

$139K

How much do claims configuration jobs pay per year?

As of Jul 17, 2026, the average yearly pay for claims configuration in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 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.
More about Claims Configuration jobs
What cities are hiring for Claims Configuration jobs? Cities with the most Claims Configuration job openings:
What states have the most Claims Configuration jobs? States with the most job openings for Claims Configuration jobs include:
What job categories do people searching Claims Configuration jobs look for? The top searched job categories for Claims Configuration jobs are:
Claims Configuration jobs near you
Infographic showing various Claims Configuration job openings in the United States as of July 2026, with employment types broken down into 91% Full Time, 7% Part Time, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.

Senior Analyst, Audit and Compliance Analytics (Hybrid NY)

Healthfirst (New York)

New York, NY • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 9 days ago

Job description

The Senior Analyst, Audit and Compliance Analytics leverages healthcare data, analytical tools, and business knowledge to support Internal Audit, Compliance Analytics, and Claims Configuration Audit initiatives. This role partners with cross-functional teams to identify risks, evaluate controls, analyze claims and configuration data, and develop reporting that supports operational excellence, compliance, and payment accuracy. The individual will work on strategic initiatives with visibility across the organization and contribute to data-driven decision making.

Duties and Responsibilities:

  • Analyze complex healthcare datasets to identify trends, anomalies, control gaps, and potential compliance or operational risks.
  • Support Internal Audit, Compliance, and Claims Configuration Audit activities through data analysis, audit testing, monitoring, and reporting.
  • Develop advanced SQL, SAS, or other analytical queries to extract, validate, and analyze data from multiple sources.
  • Evaluate data quality and standardize data structures to support consistent reporting and analysis.
  • Create and maintain dashboards, scorecards, reports, and monitoring tools that provide actionable insights to leadership and business stakeholders.
  • Summarize findings, methodologies, and recommendations for technical and non-technical audiences.
  • Assist in the validation of claims configuration changes, business rules, and operational controls.
  • Document analytical processes, data issues, methodologies, and business requirements.
  • Collaborate with Internal Audit, Compliance, Claims Operations, Configuration, IT, and other business partners.
  • Demonstrate intellectual curiosity and identify opportunities for process, control, and reporting improvements.
  • Additional duties as assigned.

Minimum Qualifications:

  • Bachelor's degree from an accredited institution or equivalent work experience
  • 3+ years of equivalent experience
  • Proficiency in scripting and programming skills
  • Experience using MS Office suite, including Microsoft Access, Excel, and Word
  • Expertise in utilizing data analysis and query tools such as SQL
  • Experience with Alteryx, Tableau, Amazon Redshift, or other similar tools/platforms
  • Experience with applied statistics skills, such as distributions, statistical testing, regression, etc.
  • Ability to successfully run queries from a data warehouse
  • Expertise innovating and implementing audit techniques
  • Excellent communication skills
  • Excellent time management and the ability to prioritize work and complete assignments within their allotted deadline
  • Experience working with and communicating technical information to multiple levels of technical and non-technical staff in written and verbal form
  • Experience prioritizing a heavy workload in a fast-paced environment

Preferred Qualifications:

  • Master's degree from an accredited institution
  • Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration
  • Experience with analytical programming techniques such as Python and R
  • Experience with AWS and analytical solutions available on the platform (Redshift, Glue, Sage Maker, etc.)
  • Familiarity with programming in JavaScript, D3.js
  • Familiarity with big data technologies, such as Hadoop, MapReduce, and AWS Kinesis
  • Demonstrated ability to develop innovative solutions to complex problems, leveraging advanced problem-solving skills and sound judgment to make critical, independent decisions within area of responsibility
  • Knowledge of modern machine learning algorithms (clustering, classification and regression), statistical methods and optimization
  • Knowledge of health care industry, systems, business strategies and products

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.orgor calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360

  • All Other Locations (within approved locations): $73,400 - $109,225

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

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