MedStar Health · 9 hours ago
Health Plan Configuration Analyst
Baltimore, MD
Full-time
Onsite
Mid Level
3+ years expMedStar Health is seeking a Health Plan Configuration Analyst responsible for analyzing business requirements and collaborating with cross-functional teams to implement changes. The role involves operational support, claims analysis, and ensuring accurate configuration integration for timely claims payment.
Health CareMedical
Responsibilities
Performs user acceptance testing and operational readiness for all lines of business programs and program enhancements ensuring all end-to-end operational impacts assessed requirements defined operations documentation completed (e.g. process flows policies and procedures) communications delivered and ongoing operations support established
Gathers business requirements and works with external vendors to ensure accurate and timely benefit configuration
Performs root cause analysis to understand claim anomalies and/or trends and identifies opportunities for improvement
Serves as subject matter expert and will work with other functional areas to respond to all configuration and claim related requests inquiries and escalations
Applies previous experience and knowledge to research and resolve minor to moderate claim/provider issues pending claims and provides guidance to third party vendor(s) as needed
Participates in meetings and on committees as assigned
Qualification
Required
Bachelor's degree required or One (1) year of relevant education may be substituted for one (1) year of required work experience
Minimum of 3 years of experience in a health plan or managed care setting, specifically supporting Claims Configuration, Customer Service, and Enrollment
One (1) year of relevant professional-level work experience may be substituted for one (1) year of required education
Strong understanding of operational activities around claims enrollment call center utilization management etc. related data
Prior experience in medical billing claims auditing and claims analysis
An in-depth understanding of national reimbursement mechanisms as well as local regulatory environment
Ability to convey verbal and written information effectively
Ability to follow verbal and written instructions
Preferred
Certified Professional Coder (CPC) Certified Professional Coder Certification preferred
Company
MedStar Health
MedStar Health is a not-for-profit healthcare organization
10001+ employees
H1B Sponsorship
MedStar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (13)
2023 (14)
2022 (14)
2021 (12)
2020 (14)
Funding
Current Stage
Late StageTotal Funding
$29MKey Investors
American Medical AssociationAgency for Healthcare Research and QualityA. James and Alice B. Clark Foundation
2023-06-21Grant
2022-09-27Grant· $2M
2020-07-03Grant· $27M
Leadership Team
David Mayer
Executive Director MedStar Institute for Quality and Safety Quality and Safety CEO Patient Safety Mo
Recent News
2025-12-17
Maryland Daily Record
2025-12-05
Company data provided by crunchbase