Benefit Plan Configurator I

Western Growers; Irvine (CA); Presencial; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Western Growers in Irvine, CA seeks a Benefits Configuration Analyst to assist with building, testing, auditing, and maintaining medical, dental, pharmacy, vision, and ancillary benefit plans for employer groups. You will translate SPD provisions into claims system configurations and support system integrity.

You will develop proficiency in benefit interpretation, QA testing, and claims adjudication workflows, collaborating with Claims Examiners and internal teams to ensure accurate plan

Formación

• BS/BA degree in Business, Computer Science, HealthCare Administration, or related field preferred.
• Minimum two (2) years of experience in health plan coding, benefit configuration, claims auditing, plan testing, or related health plan administration.
• Ability to interpret SPDs, Plan Documents, amendments and benefit summaries with guidance.
• Strong analytical skills with ability to identify discrepancies and research solutions.
• Strong written and verbal communication skills.

Responsabilidades

• Builds new business and benefit plan changes within the claims administration system under established departmental guidelines.
• 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 benefit configurations align with approved plan documents and administrative requirements.
• Assist with researching and responding to work orders from Claims Examiners and internal stakeholders regarding plan issues and benefit discrepancies.

Conocimientos

Analytical skills

Attention to detail

Communication skills

Team collaboration

Educación

BS/BA degree

Herramientas

Microsoft Word

Microsoft Excel

Descripción del empleo

Western Growers in Irvine, CA seeks a Benefits Configuration Analyst to assist with building, testing, auditing, and maintaining medical, dental, pharmacy, vision, and ancillary benefit plans for employer groups. You will translate SPD provisions into claims system configurations and support system integrity.

You will develop proficiency in benefit interpretation, QA testing, and claims adjudication workflows, collaborating with Claims Examiners and internal teams to ensure accurate plan