Configuration Specialist - Plan & Benefits Configuration

Remote

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$80,000 – $90,000Compensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates should possess knowledge of professional and institutional claims adjudication and the ability to interpret plan documents and amendments. They must be able to translate benefits into ICD 10, HCPCS, CPT, and CDT codes, demonstrate exemplary customer service skills, and adapt to a constantly changing environment. Strong organizational skills, problem-solving abilities, and the capacity to work independently in a fast-paced, agile setting are essential. Proficiency in Microsoft Office applications and other web-based software is required, along with the ability to learn new proprietary computer systems. Prior experience in a start-up environment and 4-5 years of health insurance related Plan Building experience with TPA and Self-Funding processes are preferred, as is an Associate or Bachelor's degree.

Responsibilities

The Configuration Specialist will create blueprints for plan configuration based on plan documents and standards. They will build, validate, and test medical and dental plan benefits and associated code mapping logic, making necessary revisions when plans are amended. Responsibilities include building auto-adjudication logic, testing for integration with the plan, and resolving system issues. The specialist will act as the contact for jobs on the core claims platform job list, test upgrades for new releases, and troubleshoot problems before production loading. They will also troubleshoot system problems, develop resolutions or work-around procedures, and collaborate with department managers to improve efficiency. Communicating changes to other departments and providing necessary training due to system changes are also key duties.

Skills

Claims Adjudication

Plan Configuration

Benefit Configuration

Code Mapping

System Testing

Problem Solving

Process Improvement

Communication

Centivo

Affordable health insurance with primary care focus

About Centivo

Centivo provides health insurance focused on making healthcare affordable and accessible. The company emphasizes primary care, offering free primary care services, no deductibles, and low, predictable copays to help keep its members healthier and reduce the need for hospital visits. Centivo generates revenue by charging employers for health plans provided to their employees, which leads to lower medical costs and increased usage of the plans. A key feature of Centivo's offering is its integrated virtual care service, allowing members to access care conveniently. The company is distinguished by its commitment to quality, curating providers based on strict price and quality standards, particularly in primary care. Centivo's goal is to enhance the member experience while lowering overall healthcare costs.

Buffalo, New YorkHeadquarters

2017Year Founded

$183.7MTotal Funding

DEBTCompany Stage

Financial Services, HealthcareIndustries

201-500Employees

Benefits

Insurance: Medical, dental, vision, life & diability

401k plan

Access to a health savings account

Commuting and dependent care FSA

Competitive salary, bonus, & equity

Risks

Integration challenges with Eden Health may disrupt service delivery if not managed well.

Chronic shortages in primary care access could impact Centivo's care delivery model.

Increased competition from AI-driven startups may challenge Centivo's market position.

Differentiation

Centivo emphasizes primary care partnerships to coordinate healthcare needs effectively.

The company offers free primary care, no deductibles, and low, predictable copays.

Centivo integrates virtual care and mental health services for comprehensive healthcare solutions.

Upsides

Centivo raised $75M to expand affordable health plans amid rising U.S. healthcare costs.

Acquisition of Eden Health enhances Centivo's virtual care and mental health services.

Growing trend of virtual care aligns with Centivo's integrated virtual care service.

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