Benefits Plan Architect — Remote

Centivo; Buffalo (NY); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Centivo is seeking a Benefits Plan Configuration Specialist to translate and configure medical and dental plan designs into the core claims platform. You will build logic mapping, test plan benefits, and ensure accurate claims processing while continuously evaluating processes and system capabilities.

You will work in a remote or hybrid setup from Buffalo with potential for home-based work, collaborating with managers and teams to improve efficiency and adapt to evolving plans and regulatory

Qualifications

• Experience with highly automated and integrated claim adjudication systems.
• Ability to interpret plan documents and translate benefits to ICD-10, HCPCS, CPT, CDT and other insurance codes.
• Exemplary customer service skills, resolving configuration-related issues promptly and accurately.
• Ability to adapt to a constantly changing environment and manage multiple issues under production schedules.

Responsibilities

• Create the blueprint for configuration of the plan from documents and standards.
• Build, validate and test medical and dental plan benefits and code mapping logic.
• Revise plans when amended; build auto-adjudication logic for integration.
• Troubleshoot system problems and coordinate with departments to improve efficiency.
• Communicate changes and assist with training related to system updates.
• Maintain the Plan Building mailbox to research and resolve issues.

Skills

Claims adjudication

Plan interpretation

Customer service

Adaptability

Organizational skills

Agile environment

MS Office

Learning new systems

Education

Associates or Bachelor's degree preferred

Job description

Centivo is seeking a Benefits Plan Configuration Specialist to translate and configure medical and dental plan designs into the core claims platform. You will build logic mapping, test plan benefits, and ensure accurate claims processing while continuously evaluating processes and system capabilities.

You will work in a remote or hybrid setup from Buffalo with potential for home-based work, collaborating with managers and teams to improve efficiency and adapt to evolving plans and regulatory