Benefit Configuration Analyst –HealthRules Payer

AECOM; Boston (MA); Remote; USD 125,000 - 150,000; Full time

Job summary

A leading healthcare company is seeking a Benefit Configuration Analyst in a fully remote role. The successful candidate will analyze configuration changes and ensure systems align with client needs while collaborating on the implementation of new benefit plans. Applicants should have a Bachelor's degree and two years of relevant experience, with strong problem-solving and project management skills. Knowledge of claims management systems is preferred.

Benefits

401(k) match

Tuition assistance

Time off benefits

Qualifications

• Bachelor's degree or minimum 4 years of relevant work experience.
• 2 years of experience preferred in benefit configuration.
• Experience with Health Edge's HealthRules software strongly preferred.

Responsibilities

• Execute build and implementation of benefit plan adjudication rules.
• Analyze claims data to evaluate billing patterns.
• Develop operational procedures for benefit plan configuration.

Skills

Data investigation

Problem-solving

Project management

Technical specifications

Communication skills

Education

Bachelor's degree

Tools

MS-Excel

MS-Access

SQL

Job description

**About Us**

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

+ We serve faithfully by doing what's right with a joyful heart.

+ We never settle by constantly striving for better.

+ We are in it together by supporting one another and those we serve.

+ We make an impact by taking initiative and delivering exceptional experience.

**Benefits**

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

+ Eligibility on day 1 for all benefits

+ Dollar-for-dollar 401(k) match, up to 5%

+ Debt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more

+ Immediate access to time off benefits

At Baylor Scott & White Health, your well-being is our top priority.

Note: Benefits may vary based on position type and/or level

**Job Summary**

**100% Remote position**

The Benefit Configuration Analyst examines configuration change requests. They establish the technical scope, impact on systems, and required modifications. Accountable for designing, writing, testing, training, documenting, and implementing configurations to meet customer needs.

**The pay range for this position is $25.14/hour (entry level qualifications) - $42.11/hour (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience.**

**Essential Functions of the Role**

+ Execute the build and implementation of benefit plan adjudication rules

+ Coordinate the integration or conversion of new clients and / or products as needed

+ Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components

+ Develop best practices and standard operational procedures for creating and configuring benefit plans

+ Establish consistency and standardization as it relates to tools and processes (deliverable templates, change management processes, business models, process flows, etc.)

+ Ability to execute testing to ensure the accurate configuration of business requirement

+ Analyze larger sets claims data to evaluate patterns of billing as it relates to benefit design and configuration

+ Partner with claim processors, member service and provider service to identify and resolve issues related to the plan configuration

+ Maintains assigned subsystem.

+ Monitors existing system functionality and makes recommendations, where appropriate, to maintain acceptable levels of performance, reliability, and end user satisfaction.

+ Utilizes system development lifecycle methodology to implement system changes to production environments.

+ Installs, checks quality, and tests system configurations, software changes, and upgrades. Ensures accuracy, completeness, and compatibility of changes.

+ Ensures the quality and integrity of work requests through the use of production validation and audit strategies.

+ Researches complex problems to find possible solutions. Designs and implements solutions to help key business targets. This includes developing design requirements and technical specifications.

+ Creates complex design documents by assessing requirements. Assesses design alternatives and chooses the best solution for business needs. Considers interdepartmental impact when recommending solutions.

+ Serves as an internal consultant and subject matter expert. Participates on cross-functional teams and projects. Troubleshoots inquiries and issues from other departments.

+ Develops, maintains, and disseminates internal and external configuration documentation, including status updates. Prepares procedural and customer documentation when required.

+ Perform other duties as assigned

**Key Success Factors**

+ Two years of benefit configuration experience strongly preferred (new products, authorization requirements, commercial/government/ASO lines of business).

+ Experience with Health Edge's HealthRules Payer claims management software strongly preferred.

+ Experience with benefit configuration & claim analysis strongly preferred.

+ Broad operational managed care background preferred.

+ Previous training and documentation experience preferred.

+ Exceptional data, problem-solving and project management skills.

+ Able to perform complex business and product requirement study.

+ Demonstrates a high level of skill in data investigation and query tools like MS-Access, SQL, and MS-Excel to find root-cause issues.

+ Knowledge and expertise of medical benefit policies and plan designs, claims hospital and medical processing, and adjudication with data skills.

+ Working knowledge of CPT-4, ICD-10-CM, and general medical terminology.

+ Excellent relational skills, including the ability to work with all levels of personnel.

**Belonging Statement**

We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.

**QUALIFICATIONS**

+ EDUCATION - Bachelor's or 4 years of work experience above the minimum qualifications

**EXPERIENCE**

+ 2 Years of Experience

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.