Benefit Plan Building Specialist
8162 Woodland Center Blvd Tampa, FL 33604 US
Job Description
COMPANY HIGHLIGHTS/RESPONSIBILITIES:
- Design and implement system configuration in accordance to benefit plan description.
- Build new groups and adjust systems per plan amendments in benefits system.
- Research plan provisions contained in benefit plan documents; clarify ambiguities contained in the plan language and provisions. Ensure plan language conforms to the group’s intent.
- Convert plan provisions to claim system adjudication functions.
- Construct/build benefit plans and related tables within the system.
- Coordinate the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
QUALIFICATIONS:
- Associate or bachelor’s degree preferred.
- 3+ years benefit plan build experience; alternately demonstrated progressive experience in a claims processor role of at least 5 years.
- Knowledge of benefit application and plan building for health plans.
- Knowledge and experience in medical terminology including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD) 9/ 10 required.
