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Claims Configuration Specialist (Medical), South San Francisco, CA

Health Plan of San Mateo


South San Francisco, CA

January 6, 2018

Claims Configuration Specialist (Medical)

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Configuration Specialist to monitor, develop, test, and document claim configuration changes as well as related procedural changes that are directed by state, federal, and internal policy.

The essential duties and responsibilities will include the following:

  • Research, analyze, and recommend claims system configuration modifications.
  • Develop and maintain updates of all internal and external documentation related to Claims configuration and policy changes.
  • Develop provider education/training materials as related to configuration and policy changes.
  • Continually review/audit system configuration rules to ensure accurate application of policies.
  • Keep abreast of healthcare industry best practices, system capabilities and managed care regulatory requirements.
  • Resolve provider disputes and research and resolve claim issues for providers and internal staff.
  • Coordinate and manage training associated with system changes.
  • Lead or participate in special projects as needed.


Education and Experience: High School Diploma/GED required; Bachelor's preferred. Five (5) years’ experience in health care or managed care with an emphasis on coding and billing policy. Coding Certificate preferred.

Knowledge of: Medical claims processes and procedures. Medicare and Medi-Cal programs. NCCI edits. General personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint

Ability to: Communicate effectively with strong emphasis on written communication; manage multiple projects simultaneously; interpret government rules and regulations.

Compensation & Benefits

Starting Compensation Range: - Depends on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more. Check out our full benefits package at: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx (Under Employee Benefits Tab)

How to Apply

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE

Submissions without a Cover Letter and Salary Expectations may not be considered.

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