Benefits Analysis Specialist

S&S Health; Cincinnati (AR); On-site; USD 32,000 - 40,000; Full time

Job summary

Reflect Health, the evolved form of S&S Health, seeks a Plan Benefit Analyst to analyze and support health and welfare benefit plans. You will review SPDs, plan documents, and benefit specifications to ensure accurate reflection in claims systems and processes.

The role requires strong analytical skills, attention to detail, and the ability to translate complex benefit information into practical solutions. Collaboration with multiple internal teams is essential, with no software coding involved.

Qualifications

• Experience in employee benefits, health plan administration, claims administration, or related field.
• Ability to read, understand, and interpret benefit plan documents and SPDs.
• Strong analytical, mathematical, critical-thinking, and problem-solving skills.
• Understanding of health plan concepts: deductibles, coinsurance, copayments, out-of-pocket maximums, eligibility, exclusions, accumulators, network benefits.
• Proficiency with Microsoft Office, especially Excel and Word; data/reporting tools preferred.

Responsibilities

• Review and analyze medical, dental, vision, and other benefit plan designs to understand administration.
• Interpret SPDs, plan documents, benefit summaries, amendments, and related materials.
• Research complex benefit questions involving eligibility, coverage, deductibles, coinsurance, and out-of-pocket requirements.
• Investigate claims and benefit-related issues to ensure alignment with plan provisions.
• Validate that benefit plan configurations reflect plan documents and specifications.
• Translate benefit requirements into clear specifications for claims systems."
• Participate in testing of new/modified benefit plans and resolve discrepancies before implementation.
• Collaborate with Claims, Plan Build, Client Services, Eligibility, Product Development, Compliance, and other teams.
• Support Product Development and client-related benefit questions with accurate information.
• Maintain documentation of interpretations, research findings, testing results.
• Identify opportunities to improve benefit analysis, documentation, testing, and administration processes.
• Manage multiple benefit-related requests and deadlines and communicate status to stakeholders.
• Perform other duties as assigned.

Skills

Benefits knowledge

Analytical skills

Documentation

Communication

Organization

Job description

Reflect Health, the evolved form of S&S Health, seeks a Plan Benefit Analyst to analyze and support health and welfare benefit plans. You will review SPDs, plan documents, and benefit specifications to ensure accurate reflection in claims systems and processes.

The role requires strong analytical skills, attention to detail, and the ability to translate complex benefit information into practical solutions. Collaboration with multiple internal teams is essential, with no software coding involved.