Plan Build Specialist

Job Summary:

The Benefit Plan Building Specialist constructs and implements new benefits plan in the benefits administration system. This position maintains a comprehensive understanding of the plans under their scope of responsibility and works with the Implementation Team to help onboard new clients.

Duties and Responsibilities:

• Design and implement system configuration in accordance to benefit plan description.
• Build new groups and adjust systems per plan amendments in benefits system.
• Research plan provisions contained in benefit plan documents; clarify ambiguities contained in the plan language and provisions. Ensure plan language conforms to the group's intent.
• Convert plan provisions to claim system adjudication functions.
• Construct/build benefit plans and related tables within the system.
• Coordinate the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
• Assist in developing test plans, arranging, coordinating and documenting system test cases
• Perform system loads and updates, including software, fee schedule and other data.
• Assist the with plan design testing for new clients and renewing clients to assure quality output from the system.
• Provide timely documentation to users to help them reference, understand and implement system and/or plan changes
• Update the system to ensure claims are processed in accordance with plan specifications or changes.
• Act as a resource regarding the operations and capabilities of the claim system
• Document applicable changes in related systems.
• Provide timely and thorough follow up with, internal and external customers.
• Provide ongoing feedback to help optimize system performance to ensure quality standards are met or exceeded.
• Collaborate with staff and cross-departmentally to improve or streamline plan configuration.
• Determine benefits using International Classification of Diseases (ICD), Current Procedural Technology (CPT), Health Care Provider (HCP) and Revenue Codes in association with provider specialty, age, relationship, place of service and benefit plan types.
• Update accumulators for newly implemented groups.
• Help to develop tools and best practices necessary to improve installations.
• Ensure completion of critical deliverables to assure timely and accurate implementation of our customer’s benefit plans.
• Act as primary contact/liaison between customers and company to resolve issues related to implementation plan design and customer deliverables.

Required Knowledge, Skills and Abilities:

• High school diploma or equivalent; Associates or Bachelors degree preferred
• 3+ years of benefit Plan Build experience and/or recent Claims Examiner/Processor
• Knowledge of benefit application and Plan Building for health plans required
• Knowledge and experience in medical terminology including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD) 9/ 10 required
• Javelina experience preferred
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook and PowerPoint
• Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
• Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyzes information skillfully
• Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and able to deal with frequent change, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.
• Work overtime as required, including weekends

Physical Demands: The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
• Occasional: Lift and/or move up to 10 pounds
• Constant: Regular, predictable attendance is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.

Work Environment: The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.

The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.