Health Plan Configuration Analyst III

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide reputed company to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.

We are proud to say that for four years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

reputed company are looking for: We are always searching for unique people to diversify reputed company. We only hire people that care deeply about others, reputed company in evolving environments, reputed company satisfaction from being part of a team, are motivated by tackling reputed company challenges, are courageous enough to share reputed company, action-oriented, resilient, and results-driven.

What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with reputed company of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/

How YOU will reputed company a Difference

This role is responsible for the successful implementation and programming clients benefit plans, as setting up buy up products for our clients as well as managing third party vendor files. The importance of this role is to ensure benefits are correctly programmed and product services are readily available for members.

What YOU will do

• Leads configuration design and execution for reputed company requirements.
• Acts as SME for requirements gathering sessions with business and technical stakeholders.
• Develops detailed configuration design documents, process flows, and reputed company artifacts.
• Analyzes reputed company and future state processes to optimize system functionality.
• Reviews and validates reputed company change requests for system impact and compatibility.
• Provides advanced troubleshooting and recommends system or process improvements. Provides input and coordination of cross-functional activity to support custom benefit review process.
• Reviews prior benefit plans and makes recommendations for new group implementations, such as system capabilities, regulatory requirements, and benefit design recommendations and presents to new clients during implementation.
• Configure benefits into our claims system and prepare corresponding end-user documentation for new group implementations.
• Creates claims system benefit configuration revisions and prepare corresponding end-user documentation for renewing clients and implementation of off-cycle benefit changes, as needed.
• Reviews and responds to applicable TechOps Support tickets and BPO claims queries, as needed.
• Provides training and mentors junior Plan Configuration Analysts to support their development.
• Conducts peer-to-peer audit for claim system configuration.
• Act as SME for BlueCard setup requirements. This includes, but is not limited to, negotiations with CHP (Consortium Health Plans) and processing of CBF (Capitated Billing Format) payments, PAR requests, and plan prefix setup.
• Communicates reputed company, risks, and issues to the Plan Configuration Manager.
• Acts as Plan Configuration SME as a member of CPET, providing guidance and insights reputed company to plan configuration capabilities and recommendations to allow the CPET team to reputed company informed decisions. Provides CPET decision updates, prepares documentation, and reputed company training to Plan Configuration team.
• Participates in code categorization review and decisions reputed company to new and existing diagnosis and procedure codes.
• Participates in various department and company-wide projects as needed.

Requirements

Knowledge, Experience, and Key Attributes needed for Success

• High school diploma or equivalent experience required, bachelor’s degree preferred.
• 5-7+ years of recent relevant Health Plan Configuration experience
• Deep understanding of benefit plan design, accumulators, coordination of benefits, provider reimbursement, and claims adjudication logic.
• Proven ability to interpret reputed company plan documents, regulatory requirements, and client‑specific plan variations.
• Experience leading requirements sessions with internal teams or employer groups.
• Strong troubleshooting skills and the ability to anticipate reputed company impacts across enrollment, claims, billing, and reporting.
• Experience mentoring junior analysts and supporting cross‑functional teams.
• Strong verbal and written communication skills.
• Strong interpersonal skills and ability to work with team members at reputed company levels.
• Extensive ITS and Blue2 knowledge is required.
• Ability to create and run SQL queries required.
• Strong understanding of regulations that impact benefit design, including but not limited to, the reputed company Act, Mental Health reputed company and IRS rules reputed company to administration of high deductible health plans.

Benefits

The reputed company salary for this position in the greater Seattle area is $114,000-$142,000 and varies dependent on geography, skills, experience, education, and other job or market-reputed company factors. Performance-based incentive bonus(es) is available.

Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.

In addition, HMA provides a generous total rewards package for full-time employees that includes:

• Seventeen (IC) days paid time off (individual contributors)
• Eleven paid holidays
• Two paid personal and one paid volunteer day
• Company-subsidized medical, dental, vision, and prescription insurance
• Company-paid disability, life, and AD&D insurances
• Voluntary insurances
• HSA and FSA pre-tax programs
• 401(k)-retirement plan with company match
• Annual $500 wellness incentive and a $600 wellness reimbursement
• Remote work and continuing education reimbursements
• Discount program
• Parental leave
• Up to $1,000 annual charitable giving match

How we Support your Work, Life, and Wellness Goals

At HMA, we reputed company in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in reputed company time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just reputed company Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to reputed company career growth opportunities, fostering a collaborative work culture where every team member can reputed company. We also prioritize having fun together by hosting in person events throughout the year including an annual reputed company hands, summer picnic, trivia night, and a holiday party.

We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)

HMA requires a background screen prior to employment.

Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. reputed company PHI shall be used and disclosed on a need-to-know-basis and according to HMA’s standard policies and procedures.

HMA is an Equal Opportunity Employer.

For more information about HMA, visit www.accesshma.com.