Configuration Analyst II

About the role

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. Essential Duties and Responsibilities include the following. Other duties may be assigned. 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. Supervisory Responsibilities No supervisory responsibilities Client Responsibilities This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and ass