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Healthcare Benefit Plan Analyst
2 months ago
We are seeking a highly skilled Benefit Design Configuration Analyst to join our team at Russell Tobin & Associates. As a key member of our team, you will be responsible for executing the build and implementation of benefit plan adjudication requirements.
Key Responsibilities- Develop and implement benefit plan adjudication rules and configurations
- Coordinate the integration or conversion of new clients and/or products as needed, often under aggressive timelines
- Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on system configuration and usability components
- Align operational needs with technology requirements
- Develop best practices and standard operational procedures for creating and configuring benefit plans
- Establish consistency and standardization as it relates to tools and processes
- Curate a robust testing suite that is representative of all coverage to better quantify the impact of introducing configuration changes
- Analyze issues/defects and debug the system when configuration is not producing the expected results
- Partner with claim processors, member service, and provider service to identify and resolve issues related to plan configuration
- High school diploma or equivalent
- Excellent analytical skills with ability to read and understand complex data and make thoughtful, articulate recommendations
- Experience with project methodology (requirements, design, development, testing, and implementation) including understanding Agile, inclusive of Scrum and Kanban
- Must be able to understand complex business processes that cross many functional operational units
- Knowledge of ICD-10, CPT, HCPCS, revenue codes, and medical terminology
- Demonstrated proficiency with Microsoft Excel and SQL
- Knowledge and experience in a healthcare environment with HIPAA, ERISA, and ACA requirements
- Knowledge of commercial health plan design
- Experience assisting in the plan build/plan configuration of claim adjudication platform
- Working in an ambiguous, fast-paced environment
- Agile, ready to change direction on the fly
Russell Tobin & Associates offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.