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Senior Configuration Analyst
Location
United States
Posted
2 days ago
Salary
$60.7K - $101.1K / year
Job Description
Role Description
In this role, you will play a critical part in ensuring the accurate configuration and functionality of healthcare benefit plans and claims processing systems. You will analyze plan designs, build benefit categories, and implement adjudication rules that support efficient and accurate claims processing. Working in a collaborative and mission-driven environment, you will partner with cross-functional teams to support plan implementations, troubleshoot configuration issues, and enhance automated workflows. This position offers the opportunity to contribute to innovative healthcare solutions while strengthening operational accuracy and system efficiency. Ideal candidates are analytical, detail-oriented professionals who thrive in problem-solving and continuous improvement initiatives.
- Analyze benefit plan documentation to configure benefit categories and adjudication rules for accurate claims processing.
- Create, update, and maintain benefit plans, accumulators, and related system configurations.
- Support plan implementations, renewals, and custom plan variations in collaboration with cross-functional teams.
- Troubleshoot and resolve configuration defects or discrepancies in claims processing outputs.
- Conduct root cause analysis of adjudication logic issues and recommend corrective solutions.
- Perform quality assurance reviews, regression testing, and functional testing related to configuration changes or application updates.
- Provide guidance to team members on complex configuration requests and escalation cases.
- Contribute to team development by supporting training initiatives, peer reviews, and process improvement efforts.
- Develop and maintain documentation, policies, and procedures related to benefit configurations and system processes.
- Participate in special projects aimed at improving automation and operational efficiency.
Qualifications
- 3+ years of experience configuring benefit plans, accumulators, or similar payer business logic within healthcare systems.
- 5+ years of experience working with medical claims data as a claims examiner, medical coder, or related role.
- Strong understanding of adjudication processes, benefit plan structures, and health plan information systems.
- Knowledge of self-funded or level-funded health plan designs.
- Strong analytical and problem-solving skills with the ability to diagnose configuration and claims processing issues.
- Ability to manage priorities, work independently, and meet deadlines in a fast-paced environment.
- Excellent collaboration and communication skills to work effectively across cross-functional teams.
- High attention to detail and commitment to maintaining accurate configuration data.
Requirements
- Experience with claims processing platforms such as mPhasis, Eldorado, or Javelina.
- Familiarity with EDI transaction formats including 837/835 claims and 270/271 eligibility files.
- Knowledge of healthcare coding systems such as CPT, HCPCS, ICD, and DRG.
- Experience working in high-growth or startup environments.
- Familiarity with healthcare file types such as A37, 270, 271, 276, 277, or 278.
Benefits
- Competitive salary ranging from $60,675 to $101,125 per year, depending on experience and qualifications.
- Remote-friendly work environment with flexibility.
- Comprehensive healthcare benefits.
- Opportunities for professional development and career growth.
- Collaborative and mission-driven workplace culture.
- Participation in impactful initiatives improving healthcare access and systems.
Job Requirements
- 3+ years of experience configuring benefit plans, accumulators, or similar payer business logic within healthcare systems.
- 5+ years of experience working with medical claims data as a claims examiner, medical coder, or related role.
- Strong understanding of adjudication processes, benefit plan structures, and health plan information systems.
- Knowledge of self-funded or level-funded health plan designs.
- Strong analytical and problem-solving skills with the ability to diagnose configuration and claims processing issues.
- Ability to manage priorities, work independently, and meet deadlines in a fast-paced environment.
- Excellent collaboration and communication skills to work effectively across cross-functional teams.
- High attention to detail and commitment to maintaining accurate configuration data.
- Experience with claims processing platforms such as mPhasis, Eldorado, or Javelina.
- Familiarity with EDI transaction formats including 837/835 claims and 270/271 eligibility files.
- Knowledge of healthcare coding systems such as CPT, HCPCS, ICD, and DRG.
- Experience working in high-growth or startup environments.
- Familiarity with healthcare file types such as A37, 270, 271, 276, 277, or 278.
Benefits
- Competitive salary ranging from $60,675 to $101,125 per year, depending on experience and qualifications.
- Remote-friendly work environment with flexibility.
- Comprehensive healthcare benefits.
- Opportunities for professional development and career growth.
- Collaborative and mission-driven workplace culture.
- Participation in impactful initiatives improving healthcare access and systems.
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