Hybrid Configuration Analyst – Claims & Policy Insights

Socket.dev; Naperville (IL); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Tuition reimbursement

Volunteer time off

On-site fitness center

Companywide bonus program

Hybrid work schedule

Job summary

Delta Dental of Illinois in Naperville, IL seeks a strategic and analytical Configuration Analyst to optimize claim adjudication logic within our claims administration system. You will become a SME for system configuration tools and collaborate with business units across Accounts, Benefits, Billing, Providers, and EDI processing.

The role emphasizes translating business needs into user stories and test scenarios and monitoring policy adherence.

Qualifications

• Bachelor's degree in business, insurance, or related field (or equivalent work experience).
• Strong knowledge of policy interpretation; familiarity with dental claims terminology and CDT codes.
• Strong analytical and problem-solving skills related to claims processing and/or claims administration system research.
• Experience translating business needs into user stories, acceptance criteria, or requirements.
• Strong technical skills and proficiency in Microsoft Office.
• Experience with SQL, databases, and BI tools is a plus.

Responsibilities

• Analyze and configure claim adjudication logic for claims administration system according to processing policy guidelines.
• Participate in configuration activities supporting Accounts, Benefits, Billing, Providers, Claims, and EDI processing.
• Become a subject matter expert in system configuration tools to support dental policy interpretation and plan building.
• Develop user stories, acceptance criteria, or requirements and test claim scenarios for configuration changes.
• Monitor and analyze the adjudications system’s performance for proper rule application and processing policies.

Skills

Analytical thinking

Problem solving

Interpersonal skills

Technical savvy

Microsoft Office

SQL

BI tools

Education

Bachelor’s degree in business/insurance or related field

2 Year Degree

Tools

SQL

Business Objects

Footprints

Salesforce

Crystal Reports

Database/data flow management

Job description

Delta Dental of Illinois in Naperville, IL seeks a strategic and analytical Configuration Analyst to optimize claim adjudication logic within our claims administration system. You will become a SME for system configuration tools and collaborate with business units across Accounts, Benefits, Billing, Providers, and EDI processing.

The role emphasizes translating business needs into user stories and test scenarios and monitoring policy adherence.