Benefits Plan Configuration Specialist
Centivo
We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
Centivo is looking for Benefits Plan Configuration Specialists to join our team!
As a Benefits Plan Configuration Specialist, you will focus on understanding, translating, and configuring medical and dental plan designs into the core claims platform to ensure accurate processing of claims. You will maximize effectiveness of the core claims platform by continuously evaluating current processes and business needs along with system capabilities. You will create logic sets, based on code mapping, with an emphasis on accuracy and proficiency.
We are looking for Level I - III roles.
Level I Role Responsibilities Include:
Make necessary plan building revisions when plans are amended under direction of team leadership.
Build Plan modules necessary to test for integration with plans
Works assigned items timely from Plan Building mailbox to research and resolve system issues
Level II - III Responsibilities include:
Create the blueprint for configuration of the plan from plan documents and/or plan standards.
Build, validate and test medical and dental plan benefits and associated code mapping logic.
Make necessary plan building and logic revisions when plans are amended.
Build auto-adjudication logic and test for integration with plan.
Resolve system issues and act as contact for opening and closing jobs on the core claims platform job list.
Test open jobs on new releases from the core claims platform and troubleshoot problems prior to loading into production.
Troubleshoot system problems, develop resolutions and/or “work around” procedures.
Work with Department Managers, Team Leaders, and other applicable personnel to improve efficiency within the company.
Coordinates the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
Communicate changes to other departments and help with any required training necessary because of system changes.
Maintain the claim system Plan Building mailbox to research and resolve system issues
You should have:
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 demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.
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 managing multiple issues with pressure of production schedules and deadlines.
Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.
Proficiency in Microsoft Office applications and other web-based software applications.
Ability to learn new proprietary computer systems.
Education and Experience:
Prefer 2 to 3 years of health insurance related Plan Building experience with TPA and Self-Funding processes (Level I)
Prefer 4 to 5 years of health insurance related Plan Building experience with TPA and Self-Funding processes (Level II & III)
Prior experience with a highly automated and integrated claim adjudication system.
Prior experience in a start-up environment is a plus
Associates or Bachelor’s degree preferred
Location:
This position is remote or hybrid.
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.