Configuration Analyst II

🔥 10 minutes ago

🇺🇸 United States – Remote

💵 $108k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Healthcare Management Administrators

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1986

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

<Healthcare Management Administrators> is a service-oriented health plan administrator that designs and delivers high-quality, affordable self-funded health plans for employers. The company provides benefits administration, member portals, customer care, and access to a large provider network in the Pacific Northwest, helping employers manage claims, ID cards, provider search, and care navigation. HMA focuses on improving member outcomes and reducing employer health plan costs through proactive, people-first solutions and experienced plan management.

📋 Description

• Perform system configuration and validation for new and renewing clients • Collaborate with business partners to gather and clarify requirements • Review prior benefit plans and recommend system capabilities, regulatory requirements, and benefit designs for new group implementations • Present benefit design recommendations to new clients • Configure benefits into the claims system and prepare corresponding end-user documentation • Create claims-system benefit configuration revisions and documentation for renewing clients and off-cycle benefit changes • Document workflows, configuration decisions, and process updates • Troubleshoot configuration issues and recommend solutions • Review change requests for completeness and alignment with existing processes • Provide Plan Configuration Analyst training and education and assist in developing training materials • Communicate status updates and risks to senior analysts and the Plan Configuration Manager • Review and respond to applicable TechOps Support tickets and BPO claims queries • Manage the SSO tool for non-preferred PBMs • Conduct peer-to-peer audits for claims-system configuration • Set up BlueCard requirements with a Level III analyst, including CHP negotiations, CBF payments, PAR requests, and plan-prefix setup • Work with Finance to conduct EOB setup auditing • Participate in code categorization decisions and lead reviews of annual compliance requirements related to preventative services • Participate in department and company-wide projects

🎯 Requirements

• High school diploma or equivalent experience required • 3-5+ years of recent relevant Health Plan Configuration experience • Comprehensive understanding of administered benefits and different plan types • Understanding of self-funded plan structures, accumulators, stop-loss, and employer-specific plan variations • Ability to analyze benefit documents (SPDs, plan summaries) and translate them into system rules • Understanding of regulations impacting benefit design, including the Affordable Care Act, Mental Health Parity, and IRS rules related to high-deductible health plan administration • Experience troubleshooting configuration issues and validating system outputs • Growing familiarity with claims platforms or HRP systems used by TPAs • Clear and effective verbal and written communication skills • Strong interpersonal skills and ability to work with team members at all levels • Ability to create and run SQL queries recommended • Ability to analyze and understand medical claims adjudication logic • Background screen required prior to employment

🏖️ Benefits

• 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 • Flexible work schedules • Free parking, gym, and refreshments at renovated office • In-person company events, including annual all hands, summer picnic, trivia night, and holiday party • Performance management program supporting career growth opportunities • Performance-based incentive bonus(es)

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