Benefits Plan Architect (Remote/Hybrid)

Centivo; United States; Hybrid; USD 90,000 - 130,000; Full time

Job summary

Centivo is seeking a Benefits Plan Configuration Specialist to translate and configure medical and dental plan designs into our core claims platform. You will build and test benefits logic, mapping ICD-10/CPT/HCPCS codes, and create auto-adjudication rules to ensure accurate claim processing.

You will collaborate with managers and teams to improve efficiency while supporting plan amendments and system changes in a remote or hybrid setup based in the Buffalo area.

Qualifications

• Experience with highly automated and integrated claim adjudication systems.
• Start-up environment experience is a plus.
• 4–5 years of health insurance plan building with TPA/self-funding.
• Associates or Bachelor’s degree preferred.

Responsibilities

• Create the blueprint for configuration of the plan from plan documents and standards.
• Build, validate and test medical and dental plan benefits and code mapping logic.
• Make plan building and logic revisions when plans are amended.
• Build auto-adjudication logic and test for integration with plan.
• Resolve system issues and act as contact for opening and closing jobs on the core claims platform job list.
• Test open jobs on new releases from the core claims platform and troubleshoot problems prior to loading into production.
• Troubleshoot system problems, develop resolutions and/or “work around” procedures.
• Work with Department Managers, Team Leaders, and other applicable personnel to improve efficiency within the company.
• Coordinates the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
• Communicate changes to other departments and help with any required training necessary because of system changes.
• Maintain the claim system Plan Building mailbox to research and resolve system issues.

Skills

Claims adjudication

Plan interpretation

Billing codes

Customer service

Agile environment

Organizational skills

Team collaboration

Microsoft Office

Learning new systems

Education

Associates or Bachelor's degree

Tools

None

Job description

Centivo is seeking a Benefits Plan Configuration Specialist to translate and configure medical and dental plan designs into our core claims platform. You will build and test benefits logic, mapping ICD-10/CPT/HCPCS codes, and create auto-adjudication rules to ensure accurate claim processing.

You will collaborate with managers and teams to improve efficiency while supporting plan amendments and system changes in a remote or hybrid setup based in the Buffalo area.