Highlights
High School Diploma, High School Equivalency (HSE), or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate AND an additional two (2) years of related experience may be substituted in lieu of associate’s degree. The Specialist assists with new implementations, annual renewals, plan maintenance, and routine system updates while developing expertise in health plan configuration, claims adjudication, and benefit administration.
Numbers & Facts
| Location | Fresno, California |
| Industry | Healthcare Services |
| Company Size | 10,000 employees or more |
| Year Founded | 1985 |
| Website | http://www.chs.net/ |
Description
Overview:
Qualifications:
Benefits and Opportunities for you!
- Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek
- Free Continuing Education and certification
- Tuition reimbursement, education programs and scholarships
- Vacation time starts building on Day 1, and builds with your seniority
- Free money toward retirement with a 403(b) and matching contributions
Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community. We know that our ability to provide the highest level of care is through taking care of our incredible teams.
Responsibilities:The Plan Configuration Specialist is responsible for performing routine benefit plan configuration and maintenance within the Community Care Health (CCH) claims administration system. This position supports testing, validation, and quality review activities to help ensure benefit configurations are accurate and aligned with employer plan documents, regulatory requirements, and internal standards.
The Specialist assists with new implementations, annual renewals, plan maintenance, and routine system updates while developing expertise in health plan configuration, claims adjudication, and benefit administration.
Education
- Associate's Degree in Healthcare Administration, Business Administration, Information Systems, or a related field required
- Health insurance or claims administration coursework preferred
- High School Diploma, High School Equivalency (HSE), or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate AND an additional two (2) years of related experience may be substituted in lieu of associate’s degree
Experience
- 1 year of experience in health plan claims processing, benefits administration, eligibility, plan configuration, or related health insurance operations required
- Experience using QNXT or another healthcare claims administration platform preferred
- Experience with employer-sponsored health plans preferred
- Exposure to EDI transactions (837, 835, 270/271) preferred
Licenses and Certifications
- CPC - Certified Professional Coder preferred
• Pay ranges listed are an estimate and subject to change.
• If any bonuses are noted, they are only applicable to external hires meeting criteria.
About Company
Community Health Systems, Inc. is a non-profit 501 (c) (3) 330 HRSA Grantee with Federally Qualified Health Center (FQHC) status. Established from the roots of Inland Empire Community Health Center in Bloomington, CHSI has grown with community health centers in the counties of Riverside, San Bernardino, and San Diego. These centers have been developed in accordance with standards established for safety net providers by the U.S. Department of Health and Human Services (HHS), the Health Resources Services Administration (HRSA), the Public Health Service (PHS), and the Bureau of Primary Health Care (BPHC).
As such, services are offered to the neediest in each community - the un-insured and under-insured, the working poor, those with limited ability to pay, the homeless, and the indigent. Services are provided at discounted (sliding fee scale) rates for those who qualify based on gross annual income and family size.