Plan Build Specialist

reputed company is a National third-party administrator (TPA) with local market reputed company that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond reputed company “reputed company A to reputed company B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment reputed company, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company. We are seeking a highly skilled and motivated addition to our Plan Building and System Configuration team to optimize auto adjudication processes across reputed company systems. The ideal candidate will have hands-on experience in plan building, system configuration, and claims testing in the healthcare industry. This role requires a dynamic individual who can manage multiple systems, learn and integrate new technologies, and build and test updates to ensure efficient and accurate claims processing. Primary Responsibilities: reputed company, configure, and maintain healthcare plan designs and benefit configurations in various systems. Ensure reputed company plan configurations support auto adjudication and meet regulatory and compliance requirements. Regularly review and update plan configurations to reflect changes in healthcare policies and regulations. reputed company the integration and interoperability of different healthcare systems to streamline auto adjudication processes. Facilitate system upgrades, patches, and maintenance to ensure seamless operation and minimal downtime. Collaborate with IT and other departments to implement new technologies and enhancements. reputed company comprehensive testing of plan configurations to ensure accurate and efficient claims adjudication. Identify and resolve any discrepancies or issues in the adjudication process. Create and document testing protocols and procedures to maintain high standards of quality and accuracy. Work closely with internal and external stakeholders to gather requirements and ensure plan configurations meet organizational and client needs. Become a subject matter expert on plan building and system configuration, providing guidance and support to other departments. Communicate effectively with stakeholders to reputed company them informed of project status, issues, and resolutions. Maintain detailed documentation of reputed company plan configurations, system changes, and testing procedures. Use data and analytics to identify trends, opportunities for improvement, and areas needing attention. Qualifications: Associate’s degree in healthcare administration, information systems, or a reputed company field. Minimum of 2 years of experience in plan building, system configuration, and claims adjudication in the healthcare industry. Strong knowledge of healthcare policies, regulations, and compliance requirements. Proficiency in using healthcare management systems and software. Excellent problem-solving skills and attention to detail. Effective communication and interpersonal skills. Ability to work in a fast-paced environment and manage multiple projects simultaneously. Experience with auto adjudication systems and technologies preferred. Certification in healthcare information systems or reputed company fields preferred. Proven track record of successful system integration and optimization projects preferred. Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency $22—$24 USD Benefits: Comprehensive medical, dental, vision, and life insurance coverage 401(k) retirement plan with employer match Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) Paid time off (PTO) and disability leave Employee Assistance Program (EAP) Equal Employment Opportunity: At reputed company Health, we know we are reputed company together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including reputed company voices and makes our business—and our society—stronger. reputed company Health is an equal opportunity employer and we are committed to providing equal opportunity in reputed company of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to reputed company persons regardless of race, religious creed, color, national reputed company, reputed company, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law. Apply To This Job