Senior Configuration Quality Audit Analyst

Overview

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform-bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at

Why This Role Matters

Every claim that runs through our system tells a real story - a member getting the care they need, a provider getting paid correctly, a client trusting that their plan is doing what it's supposed to do. This role is the safeguard behind that trust: catching configuration errors before they become member complaints, compliance gaps, or costly rework. When benefit plans, fee schedules, and adjudication rules are set up right, claims process faster, auto-adjudication rates climb, and clients stop worrying and start relying on us.

The audits and root-cause fixes this person drives don't just clean up today's errors - they prevent tomorrow's. Get this right, and the whole claims operation runs smoother, faster, and more accurately, directly moving the needle on the outcomes clients and members actually feel.

• Lead configuration audits: Own the end-to-end audit and validation of complex claims system configurations, confirming accuracy against client requirements, provider contracts, benefit plans, fee schedules, and regulatory guidelines.
• Translate plan language into system logic: Interpret Summary Plan Descriptions (SPDs), client-specific requirements, and contractual agreements, converting them into precise system rules, benefit matrices, and cost-sharing structures.
• Validate configuration changes: Review updates to member enrollment, provider contracts, plan design, claims processing guidelines, and system enhancements before they go live.
• Analyze claims for accuracy: Dig into complex institutional and professional claims to verify configuration, adjudication logic, and processing outcomes are working as intended.
• Resolve configuration issues at the root: Research and troubleshoot claim adjudication and configuration problems, tracing them to root cause and recommending fixes that stick.
• Build test strategies: Develop test cases and audit methodologies that support system enhancements, configuration updates, and process improvements.
• Improve auto-adjudication rates: Evaluate automated configuration solutions and identify opportunities to boost accuracy, efficiency, and straight-through processing.
• Report on quality and risk: Prepare and maintain audit results, quality metrics, and ad hoc reports that give leadership what they need to make informed decisions.
• Share findings that drive change: Communicate audit findings, trends, risks, and recommendations to internal stakeholders and leadership in a way that leads to action.
• Set the standard for audit quality: Provide subject matter expertise and mentoring to peers, helping shape audit standards, quality controls, and best practices across the team.
• Support compliance and process initiatives: Participate in cross-functional efforts focused on compliance, operational excellence, and system optimization.
• Uphold regulatory and data standards: Ensure ongoing adherence to HIPAA, claim processing requirements, and data integrity controls.

• Bachelor's degree in Healthcare Administration, Business, Information Systems, or a related field, or an equivalent combination of education…