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Claims Configuration Jobs (NOW HIRING)

Versant Health

Manager, Configuration

Troy, NY · On-site

The Manager, Configuration oversees the day-to-day operations and tactical execution of benefit configuration across the organization's core claims platforms. This role ensures accurate and timely ...

CGI Inc.

Configuration Analyst

Canton, MA · On-site

The HRP Configuration Analyst is responsible for the end-to-end configuration, maintenance, and testing of benefit and claims processing rules within the Health Rules Payor (HRP) platform by ...

Versant Health

Director, Configuration

Troy, NY · On-site

The Director, Configuration provides strategic leadership and direction for the organization's benefit configuration and claims platform operations across all core systems. This role is accountable ...

Point C

OR · On-site

Supervise the Plan Building and System Configuration team, providing coaching, performance feedback ... Claims Testing and Quality Assurance: * Direct and oversee testing efforts for new and updated ...

Photon

QNXT Benefit Configuration SME - VA

Norfolk, VA · On-site

QNXT Benefit Configuration SMEs with emphasis on commercial plans and Member, Claims, Provider, Sponsor, Benefit modules and related reference Tables. Scope of the Need : * The resources will support ...

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All JobsClaims Configuration Jobs

Claims Configuration information

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$35K

$87.9K

$139K

How much do claims configuration jobs pay per year?

As of Jun 8, 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:
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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 May 2026, with employment types broken down into 93% Full Time, 2% Part Time, and 5% 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.

HealthRules Configuration

Crea Services LLC

Sacramento, CA

Other

Posted 27 days ago

Job description

HealthRules Configuration

Sacramento, CA

Job description:

Primary Responsibilities

  • Lead HealthRules configuration activities for commercial group products, including:
    • Benefits configuration
    • Pricing and accumulator logic
    • Provider contracts
    • Claims processing rules
  • Triage, prioritize, and manage the configuration backlog, including:
    • Production defects
    • Enhancement requests
    • Annual readiness and renewal activities
  • Act as the primary intake point for configuration work from business owners and operations teams
  • Coordinate configuration handoffs and testing support with the offshore QA team
  • Provide technical guidance, oversight, and configuration code review for configuration analysts
  • Ensure configuration aligns with approved business requirements and testing standards
  • Deliver weekly status reporting to Client
  • Support operational stability
  • Operate in a ~20% supervisory / lead capacity, with the remainder in handson configuration and analysis

Required Skills & Experience

  • 7+ years of handson HealthRules Payer configuration experience
  • 3+ years supporting commercial group health plan configuration, including:
    • Deductibles
    • Outofpocket maximums
    • Accumulators
    • Tiered benefit designs
  • Expertlevel proficiency with:
    • HealthRules Designer
    • HealthRules Manager
    • HealthRules Language (HRL)
  • Demonstrated experience acting as a configuration lead or technical lead on HealthRules projects
  • Strong understanding of endtoend claims processing and benefits configuration
  • Strong communication skills with ability to:
    • Partner with business stakeholders
    • Explain technical configuration decisions clearly

Apply