Configuration Analyst II

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute system configuration and validation tasks for both new and renewing clients.

• Partner with business stakeholders to collect and clarify requirements.

• Assess previous benefit plans and propose system functionalities, regulatory needs, and benefit designs for new group implementations.

• Deliver benefit design proposals to new clients.

• Integrate benefits into the claims system and produce relevant end-user documentation.

• Generate revisions and documentation for claims-system benefit configurations for renewing clients and off-cycle benefit modifications.

• Document workflows, configuration choices, and updates to processes.

• Diagnose configuration issues and suggest effective solutions.

• Evaluate change requests for thoroughness and consistency with existing procedures.

• Offer training and education to Plan Configuration Analysts and assist in the creation of training materials.

• Share status updates and potential risks with senior analysts and the Plan Configuration Manager.

• Review and address relevant TechOps Support tickets and BPO claims inquiries.

• Oversee the SSO tool for non-preferred PBMs.

• Conduct peer audits for claims-system configurations.

• Coordinate BlueCard requirements with a Level III analyst, including negotiations with CHP, CBF payments, PAR requests, and plan-prefix setup.

• Collaborate with Finance to perform EOB setup audits.

• Engage in code categorization discussions and lead annual compliance reviews related to preventive services.

• Contribute to department and company-wide projects.

⛳️ Requirements

• High school diploma or equivalent experience is mandatory.

• 3-5+ years of recent experience in Health Plan Configuration is required.

• In-depth understanding of administered benefits and various plan types.

• Knowledge of self-funded plan structures, accumulators, stop-loss, and employer-specific plan variations.

• Capability to analyze benefit documents (SPDs, plan summaries) and convert them into system rules.

• Awareness of regulations affecting benefit design, such as the Affordable Care Act, Mental Health Parity, and IRS guidelines related to high-deductible health plan administration.

• Experience in troubleshooting configuration problems and validating system outputs.

• Increasing familiarity with claims platforms or HRP systems utilized by TPAs.

• Strong verbal and written communication skills.

• Excellent interpersonal abilities and the capacity to collaborate with team members across all levels.

• Proficiency in creating and executing SQL queries is preferred.

• Ability to analyze and comprehend medical claims adjudication logic.

• Background screening is required prior to employment.

🏝️ Benefits

• Seventeen (IC) days of paid time off (for individual contributors).

• Eleven paid holidays.

• Two paid personal days and one paid volunteer day.

• Company-subsidized medical, dental, vision, and prescription insurance.

• Company-paid disability, life, and AD&D insurance.

• Voluntary insurance options available.

• HSA and FSA pre-tax programs.

• 401(k) retirement plan with company matching contributions.

• Annual $500 wellness incentive and a $600 wellness reimbursement.

• Opportunities for remote work and continuing education reimbursements.

• Access to a discount program.

• Paid parental leave.

• Up to $1,000 annual charitable giving match.

• Flexible work schedules.

• Complimentary parking, gym access, and refreshments at the renovated office.

• In-person company events, including annual all-hands meetings, summer picnics, trivia nights, and holiday parties.

• A performance management program that supports career advancement opportunities.

• Performance-based incentive bonuses.