Benefits Plan Analyst - Analyze & Validate Health Plans

S&S Healthcare; Cincinnati (OH); Remote; USD 32,000 - 40,000; Full time

Job summary

Reflect Health in Cincinnati, OH is seeking a Plan Benefit Analyst to analyze and support health and welfare benefit plans. This role reviews plan documents, SPDs, and benefit specifications to ensure accurate reflection in claims systems.

The Plan Benefit Analyst collaborates with internal teams, translates requirements into clear specifications, and supports testing and implementation of client benefit plans to ensure accurate administration.

Qualifications

• Benefits experience in health plan administration or related field.
• Ability to read and interpret SPDs, plan documents and summaries.
• Strong analytical and problem-solving skills.
• Understanding of deductibles, coinsurance, and other plan concepts.
• Experience with health insurance claims and plan provisions.
• Familiarity with claims or benefits systems.
• Highly organized with accuracy and quality focus.
• Excellent verbal and written communication.
• Ability to prioritize multiple tasks and deadlines.
• Proficient with Microsoft Excel and Word.

Responsibilities

• Analyze medical, dental, vision benefit designs and how they are administered.
• Interpret SPDs and plan documents to guide benefit provisions.
• Research eligibility, coverage, deducibles, coinsurance, and out-of-pocket rules.
• Support testing and validation of new benefit plans.
• Collaborate with Claims, Plan Build, and Client Services teams.
• Translate requirements into specifications for claims systems.
• Investigate and resolve benefit and administration issues.
• Maintain documentation of interpretations and testing results.
• Support product development and client questions.

Skills

Benefits Experience

Plan Interpretation

Analytical Skills

Benefit Knowledge

Claims Knowledge

Systems Experience

Attention to Detail

Communication

Organization

Technology

Adaptability

Confidentiality

Collaboration

Tools

Excel

Word

Job description

Reflect Health in Cincinnati, OH is seeking a Plan Benefit Analyst to analyze and support health and welfare benefit plans. This role reviews plan documents, SPDs, and benefit specifications to ensure accurate reflection in claims systems.

The Plan Benefit Analyst collaborates with internal teams, translates requirements into clear specifications, and supports testing and implementation of client benefit plans to ensure accurate administration.