Benefit Plan Configuration Specialist – Plan Build

This is a fully remote position, open to applicants in New York.

📋 Description

• Develop plan-configuration blueprints based on plan documents and/or established standards.

• Construct, validate, and assess medical and dental plan benefits along with the corresponding code-mapping logic.

• Make adjustments to plan builds and logic whenever plans are modified.

• Establish auto-adjudication logic and verify its integration with various plans.

• Address system issues and oversee the opening and closing of jobs on the core claims platform job list.

• Evaluate open jobs in new releases of the core claims platform and troubleshoot any issues prior to production loading.

• Diagnose system problems and create resolutions or alternative procedures.

• Collaborate with Department Managers, Team Leaders, and other staff to enhance company efficiency.

• Coordinate solutions for system-related challenges that hinder automated or standard processing.

• Inform other departments of changes and provide necessary training related to system updates.

• Manage the claim-system Plan Building mailbox to investigate and resolve system-related issues.

⛳️ Requirements

• Understanding of professional and institutional claims adjudication.

• Capability to interpret plan documents and amendments, translating benefits into ICD 10, HCPCS, CPT, CDT, and other insurance billing codes.

• Outstanding customer service skills for investigating and resolving configuration-related issues.

• Flexibility to adapt to a continuously evolving environment.

• Proven organizational skills with the ability to work independently, solve problems, and make informed decisions.

• Demonstrated capacity to thrive in a fast-paced, agile setting while managing multiple issues within production schedules and deadlines.

• Proven ability to collaborate effectively and influence others across various functional teams.

• Proficiency in Microsoft Office applications and additional web-based software tools.

• Eagerness to learn new proprietary computer systems.

• Previous experience with highly automated and integrated claims adjudication systems.

• Preferred qualification of 4 to 5 years of experience in health insurance-related Plan Building, particularly with TPA and Self-Funding processes.

• Prior experience in a start-up environment is advantageous.

• An Associate's or Bachelor's degree is preferred.

• Must be authorized to work in the United States for any employer.

• Please note that Centivo does not sponsor work authorization visas at the time of initial hire or during employment.

🏝️ Benefits

• Provides equity options.

• Includes a bonus structure.

• Offers the opportunity to work from home.

• Allows for remote or hybrid work arrangements.

• Provides free primary care (including virtual options) for employees through Centivo’s benefit plan design.

• Features a predictable copay and no-deductible benefit plan design.