Virginia Premier Health Plan, Inc.

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Claim Systems Configuration Analyst I

Claim Systems Configuration Analyst I

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Job Description


This position is responsible for developing configuration solutions that support medical claim processing to ensure timely and accurate payment to providers.  The Claim System Analyst I will play a key role in implementation of new configuration, issue resolution and support of departmental initiatives.


The analyst will develop a level of expertise in the configuration of business rules that support coverage of services and provider reimbursement by the organization.


  • Perform data analysis to resolve basic claims payment discrepancies
  • Configure provider contracts
  • Maintain claim system business rules
  • Maintain system tables
  • Auto - reprocess claims
  • Perform testing to validate system configuration changes
  • Document and track system configuration changes
  • Document key business decisions and processes through process workflows
  • Report writing



  • Bachelor’s Degree in Computer Science, Information Systems, Business, or related technical field - required.


  • Operating knowledge of Microsoft Excel to include use of functions and creation of formulas
  • Demonstrated knowledge of relational databases
  • Requirements gathering
  • Basic knowledge of flow charting/process mapping


  •  1+ years business experience, preferably including Claims or Healthcare related experience



        By the end of the first year, you will have demonstrated:

  • Ability to analyze business requirements and objectives towards determining optimal configuration of the requirements
  • Ability to create test cases
  • Proficient knowledge of SQL querying
  • Proficient knowledge of the healthcare claims system


  • Physical health sufficient to meet the ergonomic standards and demands of the position


About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


Our mission is to inspire healthy living within the communities we serve!



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