centivo - Benefit Plan Configuration Specialist - Plan Build

Buffalo, New York, United States - Hybrid$63k - $73k3w ago

Remote Mid NA Health Insurance Insurance Benefits Administrator Microsoft Office Documentation

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. • Prior experience with a highly automated and integrated claim adjudication systems. • Prior experience in a start-up environment is a plus. • 4 to 5 years of health insurance related Plan Building experience with TPA and Self-Funding processes. • Associates or Bachelor’s degree preferred.

Responsibilities

• 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 open jobs 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, 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. • Maintain the claim system Plan Building mailbox to research and resolve system issues.

Benefits

• $30.29 – $35.10 per hour • Offers Equity • Offers Bonus • Pay TransparencyTo determine our base salary range, we consider as many of the following data points as are available to us: external market, salary survey data, internal data in terms of comparable roles and our budget for the position. Compensation is both an art and a science (as is negotiating a salary for a new job at a new company!), so what we have posted is our good faith estimate of a fair range for what we expect to pay. • Pay Transparency • We encourage candidates to apply for positions that are of interest and share their desired salary. We consider that as an additional data point, along with candidate skills and qualifications as part of our process. Candidates who apply that are over our budget will not be considered unless they have experience that far exceeds the requirements for our positions where that additional experience has a benefit to the business which we will assess during our recruiting process.. • Upload your resume here to autofill key application fields. • Drop your resume here! • Parsing your resume. Autofilling key fields... • What name do you want to be addressed by in our conversations? You can include pronunciation here also! • I prefer not to say. • or drag and drop here • How many years of experience do you have with automated and integrated claim adjutication systems? • How many years of experience do you have interpreting plan documents and amendments and translating benefits to ICD 10, HCPCS, CPT, and other insurance billing codes? • How many years of experience do you have working with health insurance related Plan Building experience with TPA and Self-Funding processes?