Benefits Plan Building Specialist
Benefit Plan Building Specialist
Constructs and implements new benefits plans in the benefits administration system. This position maintains a comprehensive understanding of the plans under their scope of responsibility and works with the Implementation Team to help onboard new clients.
Duties & Responsibilities:
- Design and implement system configuration in accordance to benefit plan description.
- Build new groups and adjust systems per plan amendments in benefits system.
- Research plan provisions contained in benefit plan documents; clarify ambiguities contained in the plan language and provisions. Ensure plan language conforms to the group's intent.
- Convert plan provisions to claim system adjudication functions.
- Construct/build benefit plans and related tables within the system.
- Coordinate the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
- Assist in developing test plans, arranging, coordinating and documenting system test cases.
- Perform system loads and updates, including software, fee schedule and other data.
- Assist the with plan design testing for new clients and renewing clients to assure quality output from the system.
- Provide timely documentation to users to help them reference, understand and implement system and/or plan changes.
- Update the system to ensure claims are processed in accordance with plan specifications or changes.
- Act as a resource regarding the operations and capabilities of the claim system.
- Document applicable changes in related systems.
- Provide timely and thorough follow up with, internal and external customers.
- Provide ongoing feedback to help optimize system performance to ensure quality standards are met or exceeded.
- Collaborate with staff and cross-departmentally to improve or streamline plan configuration.
- Determine benefits using International Classification of Diseases (ICD), Current Procedural Technology (CPT), Health Care Provider (HCP) and Revenue Codes in association with provider specialty, age, relationship, place of service and benefit plan types.
- Update accumulators for newly implemented groups.
- Help to develop tools and best practices necessary to improve installations.
- Ensure completion of critical deliverables to assure timely and accurate implementation of our customer’s benefit plans.
- Act as primary contact/liaison between customers and company to resolve issues related to implementation plan design and customer deliverables.
Required Knowledge, Skills and Abilities:
- High school diploma or equivalent; Associates or Bachelors degree preferred.
- 3+ years of recent Claims Examiner/Processor and/or benefit plan build experience.
- Knowledge of benefit application and plan building for health plans.
- Knowledge and experience in medical terminology including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD) 9/ 10 required.
- Javelina experience preferred.