Configuration Analyst

🔥 10 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

👻 Ghost score 15%

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Catalyst Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1999

🏥 Healthcare

💼 Consulting

🤝 B2B

Healthcare • Consulting • B2B

Catalyst Solutions is a provider of cost‑effective, intelligent business solutions exclusively to health plans, with over 25 years of experience. It offers consulting for plan strategy, operations, and technology; AI enablement; and business process outsourcing (claims, contact center, enrollment, configuration, administrative & general) delivered on its Catalyze platform or integrated with client systems. Its specialties include enterprise architecture, IT consulting, managed services, payer core systems and configurations (Facets, QNXT, Tapestry, HealthRules), clinical and care management, medical management, and systems performance optimization for managed care organizations and health plan operations.

📋 Description

• Configure and maintain health plan benefit structures in core administration systems such as QNXT, FACETS, TriZetto, Macess, or equivalent platforms • Set up and update plan benefit packages including copays, coinsurance, deductibles, out-of-pocket maximums, and coverage limits across Commercial, Medicare, Medicaid, and Exchange lines of business • Build and maintain fee schedules, provider contract rates, reimbursement methodologies, and payment rules • Implement benefit exceptions, riders, and custom plan designs according to client or regulatory requirements • Configure claim editing rules, adjudication logic, and auto-adjudication pathways • Develop and execute test scenarios to validate configuration accuracy before production implementation • Perform end-to-end claims testing to confirm benefit rules, payment logic, and adjudication outcomes • Identify, document, and resolve configuration defects and discrepancies • Collaborate with quality assurance and claims teams on post-implementation audits and retroactive reviews • Partner with product, sales, and account management teams to interpret plan design requirements and translate them into system configurations • Work with claims operations to investigate and resolve payment discrepancies, incorrect adjudications, and configuration-related claim errors • Coordinate with IT and system teams on upgrades, platform migrations, and configuration enhancements • Support provider contracting and network teams with fee schedule builds and contract rate implementation • Participate in open enrollment, plan year renewals, and regulatory change implementations • Maintain documentation of configuration builds, changes, and approvals under change control policies • Ensure configurations comply with CMS, state Medicaid agency, ACA, and other applicable regulatory requirements • Support internal and external audits with configuration documentation, test results, and change logs • Monitor regulatory updates and plan year changes and flag required configuration updates

🎯 Requirements

• Associate's or Bachelor's degree in Healthcare Administration, Information Systems, Business, or a related field; equivalent work experience considered • 2–5 years of experience in health plan configuration, benefits administration, or claims operations within a managed care or payer environment • Hands-on experience with one or more claims/benefits administration platforms (e.g., QNXT, FACETS, TriZetto, Macess, Facets, or similar) • Strong understanding of health plan benefit structures across one or more lines of business: Commercial, Medicare Advantage, Medicaid, or Exchange/ACA • Knowledge of claims adjudication principles, reimbursement methodologies (DRG, APC, RBRVS, fee-for-service), and COB rules • Familiarity with ICD-10, CPT, HCPCS, and revenue code sets as they relate to benefit configuration and claims processing • Strong analytical and problem-solving skills with high attention to detail • Proficiency in Microsoft Excel (including data analysis and validation); experience with SQL a plus • Ability to manage multiple priorities, meet deadlines, and work effectively in a fast-paced, detail-oriented environment • Preferred: Experience with Medicare Advantage or Medicaid managed care plan configuration • Preferred: Familiarity with CMS Star Ratings, HEDIS measures, or value-based care contracting as they relate to configuration • Preferred: Experience supporting open enrollment, plan year renewals, or regulatory change cycles • Preferred: Knowledge of HIPAA transaction standards (837, 835, 270/271) and their relationship to benefit configuration • Preferred: Experience with change control processes, UAT documentation, and configuration governance frameworks • Preferred: Prior exposure to provider network configuration, credentialing systems, or fee schedule management • Preferred: Relevant certifications such as CPHQ, CPMA, or health plan administration coursework

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