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Claims Configuration Jobs (NOW HIRING)

Avera Health

Configuration Analyst

Sioux Falls, SD · On-site

$53.04K - $79.56K/yr

Monitor existing system performance and make configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and member enrollment, workflows and ...

Avera Health

Configuration Analyst

Sioux Falls, SD

$53.04K - $79.56K/yr

Monitor existing system performance and make configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and member enrollment, workflows and ...

HMSA

Manager, Configuration

Honolulu, HI

* Provide strategic management and direction for the configuration of health plan products, provider ... Collaborate with external partners, IT, Claims Operations, Provider Services, Compliance, and ...

Avera Health

Configuration Analyst

Sioux Falls, SD · On-site

$53.04K - $79.56K/yr

Monitor existing system performance and make configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and member enrollment, workflows and ...

Avera Health

Configuration Analyst

Sioux Falls, SD

$53.04K - $79.56K/yr

Monitor existing system performance and make configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and member enrollment, workflows and ...

Vytwo

Health Edge Configuration Analyst

Prosper, TX · Remote

$45/hr

Required skills: 3-4 years Healthedge Source pricing configuration. 3-4 years configuration defect remediation 3-4 years working in health insurance operations 1-2 years claims processing or claims ...

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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 May 31, 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 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 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 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.

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 May 2026, with employment types broken down into 91% Full Time, 1% Part Time, and 8% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.
Medical Plan Benefit Configuration Auditor

Medical Plan Benefit Configuration Auditor

Cypress HCM

San Mateo, CA • On-site

$30 - $42.50/hr

Full-time

Posted 15 days ago

Job description


Medical Plan Benefit Configuration Auditor
Our client is looking for a meticulous and analytical Benefit Configuration Auditor contractor to join the Claims Quality Assurance team. In this role, you will be a vital safeguard, ensuring the company’s systems are configured flawlessly to match client benefit plans. You will protect plan assets, ensure compliance, and build trust by making sure every claim is paid right, every time.
What you’ll do:
  • Drive Payment Integrity: Conduct comprehensive audits of the company’s system's benefit configuration against Summary Plan Descriptions (SPDs) and other plan documents to ensure perfect alignment and accurate claims processing.
  • Ensure Coding and Regulatory Accuracy: Scrutinize medical claims for correct application of industry coding standards (ICD-10, CPT, HCPCs) and ensure the system configuration complies with all regulatory requirements, including ACA, ERISA, and other federal and state laws.
  • Investigate and Analyze: Perform deep-dive, root cause analysis on high-volume claims data to identify trends, uncover configuration gaps, and pinpoint opportunities for improvement.
  • Collaborate for Quality: Partner with internal teams, including Claims Operations, Configuration, Engineering, and Client Success, to test benefit rules, validate accumulator and provider contract setups, and communicate audit outcomes and remediation strategies clearly.
  • Develop and Recommend Solutions: Translate your findings into actionable recommendations for the Benefits Configuration team. Help establish and document new standards, policies, and procedures to enhance operational excellence.
  • Inform and Advise: Prepare and present clear, data-driven reports on audit findings, trends, and improvement initiatives for Leadership and other key stakeholders.
What you'll bring to the team:
  • Deep Healthcare Claims Expertise: 3+ years of experience in medical claims processing and system configuration within a TPA or health insurance payer environment. You have a thorough understanding of adjudication workflows, payment policies, and compliance.
  • Medical Coding Proficiency: A strong command of ICD-10, CPT, and HCPCs coding systems and their application in a payer setting. A solid understanding of medical terminology is essential. A Certified Professional Coder (CPC) or similar certification is highly preferred.
  • An Analytical and Inquisitive Mindset: You excel at researching complex issues, analyzing data to find patterns, and thinking critically to solve problems. You're comfortable challenging the status quo to drive meaningful improvements.
  • Exceptional Communication Skills: You can clearly and concisely articulate complex findings and recommendations to diverse audiences, from technical configuration teams to client-facing managers.
  • A Meticulous Eye for Detail: You are highly organized and have an unwavering commitment to accuracy, even when managing competing priorities in a fast-paced environment.
  • Comfort with Ambiguity: You thrive on creating clarity. You enjoy researching and developing consistent policies and are comfortable making well-reasoned decisions when clear answers aren't readily available.
Compensation: $30 - $42.50 per hour
ID#: 2463
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About Cypress HCM

Sourced by ZipRecruiter

We deliver consistently superior recruiting by virtue of trusting, communicative relationships with companies and candidates alike. From Fortune 100s to startups, clients lean on us to fulfill their range of needs from contract to full-time positions. With an intimate knowledge of the industries we serve, a keen sense of what makes for high-performing talent in any role, and shared sense of urgency, our clients will tell you: your solution begins here.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Walnut Creek, CA, US

Year founded

2005

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