Configuration Analyst II

MedImpact Healthcare Systems, Inc.•San Diego, CA

2d•$25 - $41•Onsite

About The Position

The Configuration Analyst II designs, builds, and maintains claims system configurations to ensure accurate, compliant adjudication across healthcare programs such as FFS and MCO. This role translates complex business and regulatory requirements into system rules—covering benefits, pricing, and edits—while collaborating with stakeholders and technical teams to ensure solutions are implemented correctly and perform as intended. The analyst supports new implementations, benefit updates, and ongoing system maintenance by troubleshooting issues and optimizing performance, while also promoting quality and operational excellence through adherence to governance standards, thorough documentation, and continuous process improvements.

Requirements

BS/BA and 2+ years’ experience or equivalent combination of education and experience
Intermediate knowledge of MS Office / Word, PowerPoint, Outlook and MS Excel.
The ability to run SQL queries and script load.
Ability to gather business requirements and client specifications.
Demonstrated ability to positively interact with clients, internal customers, and peers.
Demonstrated willingness to take accountability for achieving service commitments and a demonstrated ability to achieve results.
Demonstrates ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
Strong understanding of healthcare domain concepts, including FFS, MCO, pharmacy benefits, and plan structures.
Strong organizational and time management skills, with the ability to manage multiple priorities and meet deadlines.
Effective communication skills (written and verbal) to clearly document designs and explain complex concepts to stakeholders.
Proficiency in tools such as Excel, SQL (preferred), and ticketing/workflow systems (e.g., JIRA, SalesForce).
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Nice To Haves

Pharmacy Technician License or National Certification helpful.

Responsibilities

Configure pharmacy, formulary, and benefit plan components within the claims adjudication system to accurately implement approved change requests.
Manage assigned workload to ensure all configuration tasks and change requests are completed within established timelines and service level expectations.
Develop deep expertise in claims system logic, including adjudication processing, system constraints, benefit coding structures, and plan–group–carrier relationships to ensure configuration designs meet intended business outcomes.
Analyze, troubleshoot, and resolve basic to moderately complex claims processing issues and customer inquiries; escalate complex issues as needed while ensuring timely resolution and clear communication.
Collaborate closely with clients, business partners, and internal stakeholders to gather, clarify, and translate business requirements into effective configuration solutions that are accurately documented, developed, tested, and implemented.
Apply standardized design methodologies and governance practices to ensure configuration solutions are efficient, scalable, and sustainable; provide clear justification and documentation for non-standard designs.
Perform in-unit testing and validation to confirm configurations function as expected, meet business requirements, and support accurate claims adjudication.
Execute end-to-end workflow activities, including pre-assessment, design, configuration, and unit testing, across varying levels of complexity (Level 1–3 tasks).
Leverage strong organizational, prioritization, and project coordination skills to manage multiple initiatives while maintaining high quality and accuracy.
Support and mentor junior analysts (Level I), providing training, guidance, and assistance with more complex configuration scenarios.
Create, maintain, and enhance detailed documentation of client plan designs, including adjudication hierarchies, edits, restrictions, tables, carrier relationships, and configuration best practices.
Partner with Testing & Validation teams to ensure seamless transition of configurations into formal testing cycles and production readiness.
Contribute to continuous improvement efforts by identifying opportunities to streamline configuration processes, enhance quality, and improve overall operational efficiency.