Configuration Specialist

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

📋 Description

• Configure and oversee health benefit plans within Relation’s Third-Party Administrator's claims administration system.

• Establish deductibles, out-of-pocket maximums, copays, coinsurance, benefit limits, exclusions, and additional benefit provisions.

• Set up networks, fee schedules, reimbursement arrangements, benefit codes, system rules, and other related plan components.

• Maintain plan configurations for renewals, amendments, and changes effective on specific dates.

• Examine plan documents and supporting materials for any missing, conflicting, or ambiguous benefit information.

• Validate configured benefits against authorized plan documents and client specifications.

• Create and implement claim test scenarios to confirm benefit calculations and claims processing.

• Investigate and resolve configuration discrepancies found during testing or claims processing.

• Organize quality assurance and testing activities prior to implementation or release.

• Facilitate plan setup and processing inquiries with Claims, Eligibility, Client Services, and other internal teams.

• Document configuration changes, source materials, and outcomes of testing.

• Identify recurring configuration challenges, root causes, and opportunities for process enhancement.

• Utilize technology, automation tools, and Relation’s proprietary AI-enabled solutions to enhance configuration accuracy, testing, documentation, and workflow efficiency while safeguarding confidential information.

• Undertake other assigned projects, duties, and responsibilities.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• A minimum of two years’ experience in health benefit administration, medical claims processing, plan configuration, or a similar healthcare benefits role.

• Preferred experience in configuring health benefit plans within a third-party administrator (TPA), self-funded health plan, payer, or health plan environment.

• Familiarity with healthcare coding, HIPAA-related claims standards, or other system rules utilized in medical claims adjudication is advantageous.

• Understanding of health plan benefit structures, including deductibles, out-of-pocket maximums, copays, coinsurance, limits, and exclusions.

• Capability to interpret plan documents, benefit summaries, and client requirements, translating this information into precise system configurations.

• Competence in developing and executing benefit configuration testing and analyzing claim processing outcomes.

• Strong analytical and problem-solving abilities with a keen attention to detail.

• Proficient in identifying and resolving configuration discrepancies.

• Ability to document changes in configuration, testing results, and issue resolutions clearly and consistently.

• Proficiency in Microsoft Office.

• Ability to learn and effectively utilize claims administration, benefit configuration, and associated business systems.

• Capability to manage multiple priorities and communicate effectively with both operational and technical partners.

🏝️ Benefits

• Competitive pay.

• Family health and wellness programs.

• 401K.

• Employee assistance programs.

• Paid time off.

• Paid holidays.

• Opportunities for career advancement and development.

• Eligibility for a discretionary annual incentive program, subject to program rules and individual and organizational performance.