Benefit Plan Builder / Designer (Health Insurance)
We have an exciting new opening available for an experienced Benefit
Plan Builder / Designer.
The purpose of this position is to support the Claims and Customer
Service departments by building benefit plans in the claim processing system.
This position will evaluate the effectiveness of how the claims
processing system is being utilized by the department with a focus on
maximizing the capabilities of the system, by creating plan logics
with an emphasis on accuracy and proficiency and solving system
In addition, this position will support the customer service team by
ensuring that the benefit plans are updated and summarized to empower
the team in communicating accurate information to callers.
This position will be responsible for representing both departments
as a subject matter expert and providing guidance, training, and
suggestions on process improvements as needed.
Specific Job Responsibilities:
* Evaluate benefit plan overviews to ensure accuracy and apply
benefits levels in the system.
* Directly interact with the Sales team to capture business
requirements related to the client’s desired benefit plan design.
* Research plan provisions and clarify ambiguities contained in the
* Assist in ID card development ensuring templates are accurate
before cards are issued.
* Update coverage codes to ensure benefit level interfaces with
claims process accurately.
* Assist in development of test plans/check, leading coordination,
and documenting efforts.
* Develop/revise benefit plan overviews and benefit summaries.
* Manage tracking tool to record and document the activity of all requests.
* Create and maintain flowcharts, workflows, and ad-hoc reports as needed.
* Identify opportunities to improve performance and assist with
developing training plans.
* Perform other related duties and projects as assigned.
Knowledge, Skills, and Abilities required:
* Knowledge of eligibility guidelines.
* Skilled in WLT - MediClaims systems, preferred.
* Able to work comfortably in a fast-paced environment.
* Solid organizational skills and effective time management.
* Ability to effectively communicate both written and verbally.
* Ability to manage multiple task items simultaneously while
maintaining strict timelines.
* Ability to work independently and within a team.
* Proficient in Microsoft Excel, Word, and Access.
* Must be detailed and organized.
* Must be knowledgeable of ICD-10, CPT and HCPC codes
We offer a pleasant working culture where we support and value our employees.
This is a full time, permanent role working Monday-Friday (40 hrs.
weekly) with a great team and growing organization.
We are currently working remotely, however, once covid restrictions
ease, we will move to a hybrid working arrangement and eventually be
working on-site in our Lyndhurst, NJ headquarters.
We are an Affirmative Action - Equal Opportunity Employer (Minorities
/ Females / Vets / Disabled). We provide equal opportunities to all
employees and applicants for employment without regard to sex, race,
color, religion, marital status, national origin, age, genetic
information, sexual orientation, gender (including gender
identity/expression), disability, veteran status and military status,
pregnancy or pregnancy-related medical conditions, or any other factor
that may be protected by law.