Plan & Benefits Configuration Specialist III - Remote

Overview

As a Plan & Benefits Configuration Specialist III, you will focus on understanding, translating, and configuring medical and dental plan designs into the core claims platform to ensure accurate processing of claims.

In Short

• Create the blueprint for configuration of the plan from plan documents and/or plan standards.
• Build, validate and test medical and dental plan benefits and associated code mapping logic.
• Make necessary plan building and logic revisions when plans are amended.
• Build auto-adjudication logic and test for integration with plan.
• Resolve system issues and act as contact for opening and closing jobs on the core claims platform job list.
• Test upgrades on new releases from the core claims platform and troubleshoot problems prior to loading into production.
• Troubleshoot system problems, develop resolutions and/or “work around” procedures.
• Work with Department Managers, Supervisors, Team Leaders, and other applicable personnel to improve efficiency within the company.
• Coordinates the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
• Communicate changes to other departments and help with any required training necessary because of system changes.

Requirements

• Knowledge of professional and institutional claims adjudication.
• Ability to interpret plan documents and amendments and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes.
• Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.
• Ability to adapt to a constantly changing environment.
• Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions.
• Demonstrated ability to work in a fast-paced, agile environment managing multiple issues with pressure of production schedules and deadlines.
• Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.
• Proficiency in Microsoft Office applications and other web-based software applications.
• Ability to learn new proprietary computer systems.

Benefits

• Work remotely.
• Opportunity to work in an innovative health plan environment.
• Contribute to improving healthcare affordability.
• Engage with a supportive team culture.
• Professional growth opportunities.