Benefit Plan Configuration Analyst

Western Growers Assurance Trust; Irvine (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

Western Growers Assurance Trust is seeking a detail‑oriented professional to assist with building, testing, auditing, and maintaining medical, dental, pharmacy, vision, and ancillary benefit plans. You will translate SPD provisions into the claims system, ensure configurations align with plan documents, and support issue resolution across departments.

You will develop proficiency in interpretation, system configuration, QA testing, and claim adjudication with guidance from senior team members,

Qualifications

• Minimum two (2) years of experience in health plan coding, benefit configuration, claims auditing, plan testing, or related health plan administration.
• Ability to interpret Summary Plan Descriptions (SPDs), Plan Documents, amendments and benefit summaries with guidance.
• Strong analytical skills with ability to identify discrepancies and research solutions.
• Strong attention to detail and commitment to accuracy.
• Ability to organize and prioritize multiple tasks while meeting deadlines.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Office applications (Word and Excel).
• Ability and willingness to learn claims administration systems and benefit configuration processes.
• Demonstrated ability to work collaboratively with internal teams and escalate issues appropriately.

Responsibilities

• Benefit Plan Building & Configuration: Builds new business and benefit plan changes within the claims administration system.
• Review SPDs, Plan Documents, amendments, and benefit summaries to translate plan provisions into system configuration.
• Configure medical, dental, pharmacy, vision, and ancillary benefits as assigned.
• Ensure configurations align with approved documents and requirements.
• Assist with research and responding to work orders from Claims Examiners.
• Escalate complex configuration issues to senior team members for resolution.
• Maintain documentation of configurations, changes and completed work.
• Benefit Plan Auditing & Quality Assurance: Test benefit configurations and plan changes.
• Perform peer audits of builds to validate accuracy.
• Validate adjudication results against SPDs and documents.
• Identify discrepancies and document potential impacts; assist with audit findings.
• Maintain testing documentation and resolution tracking.
• Process Improvement & Departmental Support: Follow procedures and quality standards.
• Maintain tracking logs for builds, audits, testing, and work orders.
• Assist with updating SOPs, job aids, and training documentation.
• Identify improvement opportunities and communicate to leadership.
• Professional Development & Team Collaboration: Participate in training and knowledge-sharing initiatives.
• Develop proficiency in benefit interpretation, claims adjudication, configuration and testing.
• Seek guidance on complex designs and challenges.
• Support team initiatives and collaborative environment.
• Other duties as assigned.

Skills

Attention to detail

Analytical thinking

Written and verbal communication

MS Word & Excel

Team collaboration

Problem solving

Education

BS/BA in Business, Computer Science, Healthcare Administration, or related field

Tools

Claims administration systems

Job description

Western Growers Assurance Trust is seeking a detail‑oriented professional to assist with building, testing, auditing, and maintaining medical, dental, pharmacy, vision, and ancillary benefit plans. You will translate SPD provisions into the claims system, ensure configurations align with plan documents, and support issue resolution across departments.

You will develop proficiency in interpretation, system configuration, QA testing, and claim adjudication with guidance from senior team members,