Benefit Configuration Analyst

Job Title: Benefits Configuration Analyst – US Healthcare

Location: Bangalore & Chennai Shift: US Shift Experience: 2–5 years

About the Role:

The Benefits Configuration Analyst is responsible for configuring, testing, and maintaining healthcare benefits within administration platforms to ensure accurate claims adjudication for U.S. healthcare clients. The role requires strong analytical skills, attention to detail, and hands-on experience in benefits setup within US healthcare payor environments.

Key Responsibilities:

Benefits Configuration

· Configure healthcare benefits, eligibility rules, and provider data within the chosen benefits/claims platform (e.g., Facets, QNXT, HealthRules, Diamond, WEX/Discovery, etc.).

· Interpret Summary Plan Descriptions (SPDs), benefit booklets, and client requirements to build accurate benefit structures.

· Maintain and update benefit plans, accumulators, codes, and pricing logic.

Testing & Validation

· Perform unit testing, integration testing, and regression validation for benefit configurations.

· Partner with QA teams to troubleshoot testing discrepancies and ensure end‑to‑end accuracy.

· Conduct root‑cause analysis for configuration issues impacting claims processing.

Claims & Data Analysis

· Review claim scenarios to validate benefit setup accuracy.

· Analyze adjudication errors and implement corrective configurations.

· Support production issues by performing impact analysis and defect resolution.

Client & Cross‑Functional Collaboration

· Work closely with US-based business analysts, product owners, and operations teams to gather requirements.

· Provide clear documentation for benefit setup and configuration logic.

· Participate in client calls when required to clarify requirements or present solutions.

Required Skills & Qualifications:

· 2–5 years of experience in US Healthcare benefits configuration or claims administration.

· Hands‑on experience with any major healthcare administration platform (e.g., Facets, QNXT, HealthRules, Diamond, WGS, etc.).

· Strong understanding of US healthcare payor processes, including:

o Medical benefits

o Dental/vision benefits (optional)

o CPT, ICD, HCPCS, and revenue codes

o Benefit accumulators, copay/coinsurance logic

· Ability to interpret and translate SPDs and plan documents into system configurations.

· Strong analytical, problem‑solving, and documentation skills.

· Experience working in US shifts and supporting US clients.