Plan Builder

Job Summary

Working remotely, the full-time Plan Builder will analyze medical plan documents to accurately build and maintain clients' benefit plans using the VBA processing system, ensuring correct claim adjudication.

Key responsibilities

• Review and coordinate plan documents and amendments to ensure accurate coding of benefit levels
• Provide feedback on benefits requiring manual intervention and suggest changes for auto adjudication
• Create and maintain documentation to ensure correct claims processing and analyze issues identified through claim referrals

Required qualifications

• Minimum of 2 years of experience in building and coding medical, dental, and vision plans
• 2-3 years of experience using the VBA system
• Strong analytical skills with knowledge of CPT, HCPCS, and ICD-9 coding terminology
• General knowledge of federal laws affecting self-funding
• Proficiency in Excel and Word programs