Benefit Plan Configuration Specialist – Plan Build

Job not on LinkedIn

🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $30 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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👻 Ghost score 1%

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Centivo

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2017

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Centivo is an innovative health plan provider for self-funded employers that focuses on delivering high-quality healthcare at an affordable cost. The company believes in the power of primary care to improve health outcomes and reduce costs. Centivo offers plans with free primary care, no deductibles, and low, predictable copays, thereby encouraging members to utilize their health benefits without financial burden. The plans are curated to meet stringent price and quality standards, promoting a strong relationship with primary care providers and integrating virtual care options. Centivo's approach is designed to reduce overall medical expenses while enhancing the healthcare experience for both employers and employees.

📋 Description

• Create plan-configuration blueprints from plan documents and/or plan standards • Build, validate, and test medical and dental plan benefits and associated code-mapping logic • Revise plan builds and logic when plans are amended • Build auto-adjudication logic and test integration with plans • Resolve system issues and manage opening and closing jobs on the core claims platform job list • Test open jobs in new core claims platform releases and troubleshoot problems before production loading • Troubleshoot system problems and develop resolutions or workaround procedures • Work with Department Managers, Team Leaders, and other personnel to improve company efficiency • Coordinate solutions for system-related issues that prevent automated or standard processing • Communicate changes to other departments and support required training related to system changes • Maintain the claim-system Plan Building mailbox to research and resolve system issues

🎯 Requirements

• Knowledge of professional and institutional claims adjudication • Ability to interpret plan documents and amendments and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes • Exemplary customer service skills for researching and resolving configuration-related issues • Ability to adapt to a constantly changing environment • Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions • Demonstrated ability to work in a fast-paced, agile environment while managing multiple issues under production schedules and deadlines • Demonstrated ability to work collaboratively and influence others across multiple functional teams • Proficiency in Microsoft Office applications and other web-based software applications • Ability to learn new proprietary computer systems • Prior experience with highly automated and integrated claim adjudication systems • 4 to 5 years of health insurance-related Plan Building experience with TPA and Self-Funding processes (preferred qualification) • Prior start-up experience is a plus • Associates or Bachelor’s degree preferred • Authorized to work in the United States for any employer • Centivo does not sponsor work authorization visas at initial hire or later during employment

🏖️ Benefits

• Offers Equity • Offers Bonus • Ability to work from home • Remote or hybrid work arrangement • Free primary care (including virtual) for employees through Centivo’s benefit plan design • Predictable copay and no-deductible benefit plan design