Plan & Benefits Configuration Specialist III

Salary: $80K - $90K Employment Type: Full-Time Location Type: Remote

Position Overview

Centivo exists to provide affordable, high-quality healthcare to millions who struggle with healthcare costs. As a Plan & Benefits Configuration Specialist III, you will be instrumental in understanding, translating, and configuring medical and dental plan designs within our core claims platform. Your primary goal will be to ensure accurate claims processing and to maximize the effectiveness of the platform by continuously evaluating processes, business needs, and system capabilities. You will be responsible for creating logic sets based on code mapping, emphasizing accuracy and proficiency.

Responsibilities

• Create configuration blueprints for plans based on plan documents and/or plan standards.
• Build, validate, and test medical and dental plan benefits and associated code mapping logic.
• Implement necessary plan building and logic revisions when plans are amended.
• Build and test auto-adjudication logic for integration with the plan.
• Resolve system issues and manage the opening and closing of jobs on the core claims platform job list.
• Test upgrades and new releases from the core claims platform, troubleshooting problems before production loading.
• Troubleshoot system problems, develop resolutions, and create "work around" procedures.
• Collaborate with Department Managers, Supervisors, Team Leaders, and other personnel to enhance company efficiency.
• Coordinate the development of solutions for system-related issues that hinder automated or standard processing methods.
• Communicate system changes to other departments and provide necessary training.

Qualifications

Required Skills and Abilities

• Knowledge of professional and institutional claims adjudication.
• Ability to interpret plan documents and amendments, translating benefits into ICD 10, HCPCS, CPT, CDT, and other insurance billing codes.
• Exemplary customer service skills, including timely and accurate research and resolution of configuration-related issues.
• Adaptability to a constantly changing environment.
• Demonstrated organizational skills, ability to work independently, problem-solve, and make decisions.
• Ability to thrive in a fast-paced, agile environment, managing multiple issues under production schedules and deadlines.
• Proven ability to work collaboratively and influence cross-functional teams to achieve results.
• Proficiency in Microsoft Office applications and other web-based software.
• Ability to learn new proprietary computer systems.

Education and Experience

• Skilled in HealthRules Payer/Designer or similar core administrative applications for plan configuration.
• Prior experience in a start-up environment is a plus.
• Preferred: 4-5 years of health insurance related Plan Building experience with TPA and Self-Funding processes.
• Preferred: Associate or bachelor’s degree.

Company Information

Centivo is dedicated to transforming healthcare for workers and employers, who form the backbone of our economy. Our mission is to bring affordable, high-quality healthcare to millions who face challenges paying their medical bills.

Centivo Values

• Resilient: We tackle complex challenges in healthcare affordability with determination and persistence.
• Uncommon: We are building a better healthcare system from the ground up, challenging the status quo to improve outcomes for members, employers, and providers.
• Positive: We foster a supportive environment, valuing care, providing recognition, and offering constructive feedback to help each other succeed.