Plan Build Auditor

🔥 16 hours ago

❄️ Minnesota – Remote

❄️ Minnesota – Remote

💵 $75k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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HealthEZ

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1982

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

HealthEZ is a third-party administrator that designs and administers self-funded employee health benefit plans for employers and brokers. The company focuses on customized plan design, cost containment (including reference-based pricing and prescription management), provider network management, and 24/7 member support, backed by mobile and online tools to improve member experience and reduce healthcare spending.

📋 Description

• Review and validate new and modified benefit plan configurations against approved requirements, plan documents, and configuration standards • Validate system configuration outcomes through structured testing and claim adjudication review • Review benefit structures, coverage limitations, accumulators, cost-share arrangements, provider network configurations, pricing methodologies, denial logic, exception codes, member responsibility indicators, remit messaging, and claim processing outcomes • Document audit findings, communicate recommendations, and track resolution activities through completion • Perform follow-up reviews to validate corrective actions • Analyze audit findings and recommend improvements to configuration quality and consistency • Maintain audit documentation and support quality, accuracy, and implementation-readiness reporting • Configure and maintain benefit plans according to approved requirements and business specifications • Interpret plan documents and translate business requirements into system configuration • Support implementations for new and existing clients, benefit changes, and system enhancements • Participate in testing for configuration changes, system upgrades, regulatory updates, and operational initiatives • Serve as a resource for complex configuration scenarios and adjudication-related questions • Collaborate with cross-functional teams on implementation and operational performance • Promote configuration standards, procedures, and departmental best practices • Identify opportunities to strengthen quality controls and reduce configuration-related defects • Conduct ongoing trend analysis of audit findings and quality results • Provide feedback and recommendations to address recurring issues and improve configuration accuracy • Update audit procedures, testing standards, configuration guidelines, and related documentation • Partner with leadership and team members to improve operational efficiency, consistency, and quality outcomes • Participate in departmental initiatives and special projects

🎯 Requirements

• Minimum of five years of experience in health plan configuration, claims administration, benefit plan operations, or a related healthcare environment • At least 1 year of VBA software knowledge; 2 years preferred • Demonstrated knowledge of benefit plan design, claims adjudication, and configuration methodology • Experience interpreting plan documents and translating requirements into system configuration • Strong understanding of accumulators, limitations, exclusions, cost-share structures, and claim processing logic • Experience performing testing, validation, or quality review activities within a plan configuration environment • Strong analytical, problem-solving, and organizational skills • Excellent attention to detail and commitment to accuracy • Effective written and verbal communication skills • Proficiency with Microsoft Excel and other business reporting tools • Associate's or Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field preferred • Experience auditing benefit plan configurations or implementation deliverables preferred • Experience within a health plan, third-party administrator (TPA), or healthcare payer environment preferred • Knowledge of exception codes, claim messaging, and adjudication-related configuration preferred • Experience supporting implementation projects and system enhancement initiatives preferred

🏖️ Benefits

• Health benefits • Retirement plan (401k) • Paid time off • Paid leave, including parental leave