Health Plan Configuration Architect

Catalyst Solutions; United States; Remote; USD 70,000 - 120,000; Full time

Job summary

Catalyst Solutions is seeking a Health Plans Configuration Analyst to ensure accurate setup, maintenance, and testing of health plan benefit configurations across multiple lines of business in core claims systems. You will translate plan requirements into precise configurations guiding claims payment and member benefit delivery.

Responsibilities include configuring benefit structures, fee schedules, and adjudication rules, plus collaborating with product, IT, and claims teams to implement

Qualifications

• Strong analytical and problem-solving abilities with high attention to detail.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent communication and collaboration across cross-functional teams.

Responsibilities

• Configure and maintain health plan benefit structures in core administration systems (QNXT, FACETS, TriZetto, Macess or equivalent).
• Set up and update plan benefit packages including copays, coinsurance, deductibles, and OOP max across lines of business.
• Build and maintain fee schedules, provider contract rates, and reimbursement methodologies.
• Configure claim editing rules, adjudication logic, and auto-adjudication pathways for accurate processing.
• Develop test scenarios and validate configuration before production implementation; perform end-to-end testing.

Job description

Catalyst Solutions is seeking a Health Plans Configuration Analyst to ensure accurate setup, maintenance, and testing of health plan benefit configurations across multiple lines of business in core claims systems. You will translate plan requirements into precise configurations guiding claims payment and member benefit delivery.

Responsibilities include configuring benefit structures, fee schedules, and adjudication rules, plus collaborating with product, IT, and claims teams to implement