Benefits Plan Analyst: Analyze & Validate Plans

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

Job summary

Reflect Health in Mason, OH is seeking 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.

You will collaborate with Claims, Plan Build, Client Services, Eligibility, and Compliance to research questions, validate configurations, and translate complex benefit information into clear specifications for technical teams. No coding required.

Qualifications

• Ability to read, understand, and interpret benefit plan documents, SPDs, and related materials.
• Strong analytical, mathematical, critical-thinking, and problem-solving skills with the ability to research complex questions and determine appropriate solutions.
• Experience with benefits or health plan administration is preferred.

Responsibilities

• Benefit Plan Analysis: Review and analyze medical, dental, vision, and other benefit plan designs, specifications, and requirements to understand how benefits should be administered.
• Plan Document Interpretation: Review SPDs, plan documents, benefit summaries, amendments, and other supporting documentation and interpret applicable plan provisions.
• Benefit Research: Research complex benefit questions involving eligibility, coverage, limitations, exclusions, deductibles, coinsurance, out-of-pocket requirements, accumulators, and other plan provisions.
• Claims Support: Research claims and benefit-related issues to determine whether claims have been administered consistently with applicable plan provisions and identify potential discrepancies.
• System Validation: Work with Plan Build and other system teams to validate that benefit plan configurations accurately reflect plan documents and specifications.

Skills

Analytical skills

Attention to detail

Communication

Organization

Adaptability

Collaboration

Problem-solving

Mathematical

Tools

Excel

Word

Reporting tools

Job description

Reflect Health in Mason, OH is seeking 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.

You will collaborate with Claims, Plan Build, Client Services, Eligibility, and Compliance to research questions, validate configurations, and translate complex benefit information into clear specifications for technical teams. No coding required.