Benefits Plan Configuration Specialist

Job Summary

Focusing on the configuration of medical and dental plans, the full-time Benefits Plan Configuration Specialist will work remotely to translate plan designs into the core claims platform, ensuring accurate claims processing while continuously evaluating and improving system capabilities.

Key responsibilities:

• Create blueprints for plan configuration from plan documents and standards
• Build, validate, and test medical and dental plan benefits and associated code mapping logic
• Resolve system issues and serve as the contact for managing jobs on the core claims platform

Required qualifications:

• Knowledge of professional and institutional claims adjudication
• Ability to interpret plan documents and translate benefits to relevant insurance billing codes
• Prior experience with highly automated claim adjudication systems
• 4 to 5 years of health insurance related Plan Building experience preferred
• Associates or Bachelor's degree preferred