Benefits Configuration Analyst: Claims & Compliance

Solis-Health-Plans; Florida; On-site; USD 60,000 - 70,000; Full time

Job summary

Solis-Health-Plans in Doral, FL is seeking a Benefits Analyst to configure, maintain, and validate member benefits across claims platforms, ensuring accurate payments per plan design and CMS requirements.

The role translates benefit plan documents and regulatory guidance into system configurations, supports annual updates, and collaborates with Product, Actuarial, Compliance, and Claims Operations teams to ensure timely, compliant benefit changes.

Qualifications

• High School Diploma or GED required.
• 3–5 years of experience in health insurance, managed care, claims configuration, or benefit administration.
• Experience with benefit plan documents and claims adjudication systems.
• Strong understanding of healthcare benefits structure and claims processing concepts.

Responsibilities

• Configure annual and ongoing benefit updates in claims systems.
• Translate benefit documents, summaries of benefits, and regulatory guidance into system rules.
• Ensure benefits support correct claims payments per plan design.
• Build and maintain benefit plans.
• Support testing and regulatory compliance activities.
• Collaborate with Product, Actuarial, Compliance, and Claims Operations teams.

Skills

Analytical skills

Regulatory understanding

Effective communication

Healthcare claims knowledge

Education

High School Diploma or GED

Job description

Solis-Health-Plans in Doral, FL is seeking a Benefits Analyst to configure, maintain, and validate member benefits across claims platforms, ensuring accurate payments per plan design and CMS requirements.

The role translates benefit plan documents and regulatory guidance into system configurations, supports annual updates, and collaborates with Product, Actuarial, Compliance, and Claims Operations teams to ensure timely, compliant benefit changes.