Benefit Plan Configurator & QA Specialist

Western Growers; Irvine (CA); Presencial; USD 65.000 - 90.000; Tempo integral

Resumo da vaga

Western Growers in Irvine, CA seeks a Benefits Configuration and Quality Assurance Associate 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 system configurations and support plan administration with care and accuracy.

This role emphasizes plan interpretation, system configuration, QA testing, and claims adjudication processes, with guidance from senior team

Qualificações

• BS/BA degree preferred; 2+ years in health plan coding, benefit configuration, claims auditing, plan testing, or related administration.
• Ability to interpret SPDs, Plan Documents, amendments and benefit summaries.
• Strong analytical, detail-oriented, and time-management skills.
• Proficient with Microsoft Office (Word/Excel) and able to learn new systems.

Responsabilidades

• Assist with building, testing, auditing, and maintaining medical, dental, pharmacy, vision, and ancillary benefit plans.
• Translate plan provisions into claims administration system configurations.
• Perform benefit builds and testing under guidance from senior team members.
• Document configurations and track work orders, audits, and testing results.
• Collaborate with internal teams to resolve issues and ensure accurate benefit implementation.
• Escalate complex issues to senior team members and maintain SOPs and training docs.

Conhecimentos

Health plan configuration

Claims auditing

Plan testing

SPD interpretation

Analytical thinking

Attention to detail

Formação

BS/BA in Business, CS, Healthcare Admin or related field

Ferramentas

Microsoft Word

Microsoft Excel

Descrição da vaga

Western Growers in Irvine, CA seeks a Benefits Configuration and Quality Assurance Associate 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 system configurations and support plan administration with care and accuracy.

This role emphasizes plan interpretation, system configuration, QA testing, and claims adjudication processes, with guidance from senior team