Senior Plan Building Analyst

4 days ago

San Francisco, California, United States Angle Health Full time
Job Description

**About Us**

At Angle Health, we are a digital-first, data-driven health plan that is revolutionizing the healthcare system by making it more accessible, transparent, and easy to navigate. We are committed to delivering our members the care they need when they need it.

**Job Summary**

We are seeking a highly motivated and experienced Plan Building Analyst to join our Operations team. The successful candidate will have a strong background in benefits configuration, claim plan building, and analytical skills. The ideal candidate will be able to lead and oversee daily operations of claim plan building, manage midyear, new, and renewal plan setup, and review and update plans based on regulatory updates.

**Key Responsibilities**

  • **Benefits Configuration**: Ensure a high level of quality and accuracy through plan, benefit, and claim coding configuration while serving as a subject matter expert on benefits and claim adjudication system setup.
  • **Plan Review and Management**: Strong ability to autonomously review plan documents and ask clarifying questions both externally and internally, to align plan configuration according to plan guidelines.
  • **Claim Coding and Benefits Changes**: Responsible for the accurate review and management of plan benefits coding changes, test execution, and validation efforts of plan benefit design request.
  • **Auto-Adjudication Claim Processes**: Lead and build out auto-adjudication claim processes with internal teams, always driving for further improvement.
  • **Client and Team Communication**: Skilled in leading call discussions with external clients and internal teams to discuss questions and determine the proper course of action.
  • **Regulatory Compliance**: Possess a strong background in regulatory plan compliance, including knowledge of state and federal laws applicable to fully insured and self-funded ERISA plans and benefit configuration, as well as, but not limited to, HIPAA, the Affordable Care Act (ACA) including No Surprises Act and the Consolidated Appropriations Act, 2021 (CAA).
  • **Business Requirements Evaluation**: Evaluate new business requirements for benefit design changes to establish the appropriate solution.
  • **Documentation and SOPs**: Create and preserve proper plan and technical documentation to support and validate plan configuration, and effectively document plan configuration and rules into an easy-to-use Standard Operation Procedure (SOP) and/or plan processing guideline for internal teams to follow.
  • **Team Collaboration and Communication**: Actively participates in and contributes to daily communications, team meetings, and project/issue resolution.
  • **Deliverables and Agile Team Setting**: Completes deliverables independently and within an agile team setting.

**Requirements**

  • 5+ years of experience in benefit plan configuration/analysis/plan building.
  • Strong understanding of claims coding as it relates to plan setup and claims processing.
  • Strong attention to detail, critical thinking, problem-solving, and analytical skills.
  • Highly organized and detail-oriented.
  • Ability to work both independently and within a team as a contributor in a fast-paced, changing environment.
  • Excellent communication skills, both written and verbal.

**Preferred Qualifications**

  • Experience in building plans within the VBASoftware claims processing system.
  • Experience working for a startup.
  • Understanding of electronic claim exchanges and network routing.
  • Bachelor's degree, or equivalent work experience.

**What We Offer**

  • Competitive compensation and stock options.
  • 100% company-paid comprehensive health, vision & dental insurance for you and your dependents.
  • Supplemental Life, AD&D and Short-Term Disability coverage options.
  • Discretionary time off.
  • Opportunity for rapid career progression.
  • Relocation assistance (if relocation is required).
  • 3 months of paid parental leave and flexible return to work policy (after 10 months of employment).
  • Work-from-home stipend for remote employees.
  • Company provided lunch for in-office employees.
  • 401(k) account.

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