Senior Configuration Analyst (Health Plan Administration)

TL;DR

Senior Configuration Analyst (Health Plan Administration): Analyze benefit plan documents to build benefit categories and adjudication rules for accurate claims processing with an accent on accumulators, plan designs, and coding systems. Focus on developing automation solutions for workflows, troubleshooting defects, and performing root cause analysis.

Location: Remote (US)

Salary: $60,675–$101,125 annually

Company

hirify.global improves the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions.

What you will do

• Analyze benefit plan documents to build benefit categories and adjudication rules for efficient claims processing.
• Lead on configuration team with training, process development, peer review, and QA.
• Support cross-functional teams during implementations, renewals, and plan variations.
• Handle escalations, complex requests, root cause analysis of defects, and special projects.
• Create/update documentation for accumulators and plan configurations.
• Perform quality reviews, regression, and functional testing for changes and updates.

Requirements

• 3+ years configuring accumulators and benefit plans or related payer business logic experience.
• 5+ years as claims examiner, coder, or working with medical claims data.
• Experience with adjudication processes, plan designs, and health plan systems.
• Knowledge of self-funded and level-funded plan designs.
• Ability to prioritize, manage time, work independently, and collaborate effectively.

Nice to have

• Familiarity with mPhasis, Eldorado, Javelina claims processing software.
• Knowledge of EDI formats (837/835, 270/271) and coding systems (CPT/HCPCS, ICD, DRG).
• Experience with file types 837, 270, 271, 276, 277, 278.
• Experience in rapidly-growing startup environments.

Culture & Benefits

• Commitment to core competencies: authentic, curious, creative, empathetic, outcome-oriented.
• Diverse team environment encouraging authenticity.