Configuration Analyst, Sr

Socket.dev; Bellaire (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Texas Children's Health Plan is seeking a Senior Configuration Analyst to manage complex system updates across multiple configuration areas. You will design configurations for coding, contracts, benefits, and fee schedules, and support testing, documentation, and quality audits.

The role emphasizes collaboration with the Configuration Lead, handling high-volume workloads, and ensuring timely, accurate production changes in a regulated health plan environment.

Qualifications

• Requires 4 years in managed care, claims processing, or configuration of benefits/contracts/fee schedules/medical policy payment rules.
• Bachelor's degree may substitute for two years of required work experience.
• HS Diploma or GED required.

Responsibilities

• Performs daily configuration changes in claim adjudication systems.
• Analyzes incoming requests and designs configuration solutions to meet business requirements.
• Performs configuration changes for coding, contracts, benefits, fee schedules and claim editing rules as needed.
• Collaborates with the Configuration Lead to ensure that the solution will meet/exceed the configuration request.
• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.
• Maintains thorough and concise documentation for tracking of all contracts, benefit, fee schedule and claim editing rule changes related to Change Control Management or issues for quality audit purposes.
• Supports claims staff with moderately complex claims issues.
• Executes configuration changes in an accurate and timely manner to meet the department’s standards for quality and turnaround times.
• Collaborates with person development of configuration standards and best practices.
• Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.
• Performs peer reviews and testing of configuration changes done in the lower environments to confirm accuracy before changes are deployed in the production environment.
• Monitors pended claims and work queues to update appropriate systems. Responsible for escalating identified issues, making recommendations and assisting with implementing configuration changes to improve accuracy and efficiency of processes.
• Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
• Performs system configuration design analysis associated with multiple areas of configuration with one project.
• Analyzes configuration errors and identifies required modifications.
• Supports new system implementations and upgrades.

Skills

Configuration changes

Claims processing

Documentation

Quality assurance

Cross-functional collaboration

Education

High School Diploma or GED

Bachelor's degree preferred

Bachelor's degree may substitute for 2 years experience

Job description

We’re looking for a Senior Configuration Analyst, someone who’s ready to grow with our company. In this position you will be responsible for the activities related to advanced system updates that can impact more than one piece of the configuration. New health plan implementations and conversions within Business Operations. Designs configurations solutions to meet new business requirements and performs updates for benefits, coding, contracts, fee schedules and claim editing rules in adherence with business policies and state requirements.

Think you’ve got what it takes?

Job Duties & Responsibilities

• Performs daily configuration changes in claim adjudication systems.
• Analyzes incoming requests and designs configuration solutions to meet business requirements.
• Performs configuration changes for coding, contracts, benefits, fee schedules and claim editing rules as needed.
• Collaborate with the Configuration Lead to ensure that the solution will meet/exceed the configuration request
• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions.
• Maintains thorough and concise documentation for tracking of all contracts, benefit, fee schedule and claim editing rule changes related to Change Control Management or issues for quality audit purposes.
• Supports claims staff with moderately complex claims issues.
• Executes configuration changes in an accurate and timely manner to meet the department’s standards for quality and turnaround times.
• Collaborates with person development of configuration standards and best practices.
• Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.
• Performs peer reviews and testing of configuration changes done in the lower environments to confirm accuracy before changes are deployed in the production environment.
• Monitors pended claims and work queues to update appropriate systems. Responsible for escalating identified issues, making recommendations and assisting with implementing configuration changes to improve accuracy and efficiency of processes.
• Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
• Performs system configuration design analysis associated with multiple areas of configuration with one project.
• Analyzes configuration errors and identifies required modifications.
• Supports new system implementations and upgrades.

Skills & Requirements

• Required H.S. Diploma or GED
• Preferred bachelor's degree
• Required 4 years Managed care, claims processing, and/or configuration of benefits/contracts/fee schedules/medical policy payment rules
• A bachelor's degree may substitute for two (2) years of required work experience

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.