Benefit Plan Configuration Specialist

MAFÉ Resources; Orlando (FL); Remote; USD 86,000 - 129,000; Full time

Job summary

MAFÉ Resources is seeking a Benefit Plan Configuration Specialist to develop and maintain client benefit plans within a health benefits system. This fully remote, full-time position involves configuring benefit structures, ensuring accurate documentation, and supporting onboarding for new clients, with a competitive salary and comprehensive benefits.

Benefits

100% employer-covered health coverage for employee and family

Annual Performance Bonus

Qualifications

• Minimum of 3 years’ experience in health plan configuration or claims review.
• Capable of working independently in a remote environment.
• Adaptable to evolving systems and project timelines.

Responsibilities

• Configure benefit structures and translate plan guidelines.
• Troubleshoot system issues and propose solutions.
• Assist with quality assurance testing and manage documentation.

Skills

Interpreting healthcare codes

Attention to detail

Organizational skills

Collaboration

Education

High school diploma or equivalent

Associate or bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Outlook

Microsoft Word

Administrative systems (Javelina)

Job description

Direct message the job poster from MAFÉ Resources

Job Title: Benefit Plan Configuration Specialist in a TPA

Location: Fully Remote

Employment Type: Full-Time

• Incentives: Annual Performance Bonus
• Benefits: 100% employer-covered health coverage for employee and family
• Schedule: Remote/Work-from-home

Position Summary:

The Benefit Plan Configuration Specialist is responsible for developing and updating client benefit plans within a health benefits system. This role ensures that plan specifications are accurately reflected in the system and supports onboarding efforts for new clients by aligning configuration with documented plan design.

Core Responsibilities:

• Configure benefit structures and group details according to plan documentation.
• Translate plan guidelines into system rules that drive claims processing.
• Review and interpret policy language to clarify any inconsistencies or questions.
• Troubleshoot system issues and propose workarounds or configuration solutions.
• Load fee schedules and perform other system updates as needed.
• Assist with quality assurance testing and implementation tracking.
• Maintain and update configuration documentation for team and client use.
• Monitor system behavior to confirm plan logic is being applied correctly.
• Work closely with internal teams to refine implementation practices and tools.
• Apply standardized code sets (e.g., ICD, CPT, HCPCS) to align with plan rules.
• Manage accumulator updates and validate configuration accuracy for new clients.
• Serve as a point of contact during onboarding for benefit configuration inquiries.

Qualifications:

• High school diploma or equivalent required; associate or bachelor's degree preferred.
• Minimum of 3 years’ experience working with health plan configuration or claims review.
• Proficient in interpreting healthcare codes and benefit plan language.
• Familiarity with administrative systems (Javelina experience is a plus).
• Skilled in Microsoft Office tools, especially Excel, Outlook, and Word.
• Strong attention to detail and organizational skills.
• Capable of working independently in a remote environment.
• Comfortable collaborating across departments and with external clients.
• Adaptable to evolving systems, procedures, and project timelines.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Human Resources

• Industries

  Insurance

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Paid paternity leave

Paid maternity leave

Child care support

Pension plan

Disability insurance

Student loan assistance

Tuition assistance

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