Configuration Analyst

COMPANY OVERVIEW:

HealthAxis is a prominent provider of core administrative processing system (CAPS) technology, business process as a service (BPaaS), and business process outsourcing (BPO) capabilities to healthcare payers, risk-bearing providers, and third-party administrators. We are transforming the way healthcare is administered by providing innovative technology and services that uniquely solve critical healthcare payer challenges negatively impacting member and provider experiences.

We live and work with purpose, care about others, act with integrity, communicate with transparency, and don’t take ourselves too seriously.

We're not just about business – we're about people. Our commitment to a people-first approach shapes everything we do, from collaborating as a team to serving our valued clients. We believe that creating a vibrant and human-centric environment can inspire engagement, empower our team members, and ignite a sense of purpose in all that we accomplish.

PURPOSE AND SCOPE:

The primary purpose of the Configuration Analyst role in a Health Plan Operations setting is to ensure that health plan systems and software are accurately configured to support business operations, regulatory compliance, and the efficient delivery of services to members. This includes configuring systems for benefits administration, claims processing, eligibility, provider management, and other operational processes to meet the specific needs of the organization and comply with industry regulations.

Configuration Analysts work to ensure that systems are configured correctly and efficiently so that health plans can operate smoothly, provide accurate member services, and comply with evolving regulatory standards. They act as a bridge between technical teams and business units, ensuring that the health plan’s systems and technology are aligned with operational requirements and business goals.

PRINCIPAL RESPONSIBILITIES AND DUTIES

System Configuration & Maintenance:

• Configure and maintain health plan software systems (e.g., claims processing systems, eligibility systems) to ensure they align with business needs, regulatory requirements, and internal processes.

• Ensure proper configuration of health plan products, plan designs, networks, and benefits structures.

Business Rule Configuration:

• Define and implement business rules and logic for claims processing, member eligibility, benefits administration, and provider contracts.

• Collaborate with stakeholders to identify and document business requirements for system configuration.

Quality Assurance & Testing:

• Perform system testing to ensure accurate configuration of health plan systems and software.

• Conduct test scenarios to validate that configurations meet business requirements and regulatory guidelines.

• Document and troubleshoot any discrepancies or errors found during testing, and work to resolve them.

Data Integration & Management:

• Manage and configure data feeds from external vendors or internal systems (e.g., eligibility data, claims data, pharmacy data) to ensure proper integration into health plan systems.

• Maintain data integrity by configuring processes that ensure accurate and timely data transfer between systems.

Compliance & Regulatory Updates:

• Stay up-to-date with federal, state, and local health plan regulations (e.g., ACA, HIPAA) and ensure system configurations comply with these standards.

• Implement necessary changes in the system configurations to reflect new or updated compliance requirements, such as changes in benefit design, enrollment procedures, or reimbursement models.

Reporting & Analysis:

• Generate configuration-related reports to assess system performance, identify trends, and support decision-making.

• Monitor the impact of configurations on key performance indicators (KPIs) and assist in resolving configuration-related issues affecting operational efficiency.

Stakeholder Communication & Support:

• Work closely with business stakeholders (e.g., claims, customer service, provider relations, finance) to understand needs and develop appropriate system configurations.

• Provide support and training to internal teams on system configurations and how they impact health plan operations.

Troubleshooting and Issue Resolution:

• Investigate and resolve issues related to system configurations, such as claims payment errors, eligibility discrepancies, and provider network mismatches.

• Act as a point of contact for configuration-related issues, collaborating with IT and other departments to implement solutions.

Documentation & Process Improvement:

• Maintain thorough documentation of all system configurations, processes, and changes made to the systems.

• Identify opportunities for process improvements in the configuration management lifecycle and propose solutions for more efficient workflows.

Project Support:

• Assist in projects related to new product launches, benefit design updates, or system enhancements by ensuring configurations meet the project requirements.

• Support project teams in assessing the impacts of changes to system configurations and help manage the transition.

Cross-functional Collaboration:

• Collaborate with IT developers, business analysts, and other departments to ensure the smooth implementation and ongoing support of health plan system configurations.

• Participate in cross-functional meetings to review system updates, troubleshoot issues, and suggest improvements.

Training & Development:

• Provide training for internal teams (such as claims or customer service) on new configuration setups or system changes.

• Develop user guides or training materials to help teams understand system configurations and their impact on daily operations.

EDUCATION, EXPERIENCE AND REQUIRED SKILLS:

• An undergraduate degree in business administration, information science, computer science, industrial engineering, or a related discipline from an accredited institution of higher learning preferred.

• Minimum of two years of project analyst or database analyst experience, preferably in a medium to large health care or related organization.

• Preferred 5+ years of experience in Health Plan Operations configuration.

• An equivalent combination of education, training, and experience.