Benefits Plan Configuration Specialist (Fully Remote)

Centivo; United States; Hybrid; USD 80,000 - 110,000; Full time

Job summary

Centivo is an innovative health plan for self-funded employers. This role focuses on configuring plan rules from plan documents and standards, building, validating, and testing medical and dental benefits, and translating the benefits into ICD-10, HCPCS, CPT, CDT and other insurance billing codes.

You will ensure the configuration aligns with evolving plan amendments and regulatory requirements. The position can be remote or hybrid, with an ideal candidate assigned to the Buffalo Office.

Qualifications

• Knowledge of professional and institutional claims adjudication.
• Ability to interpret plan documents and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes.
• Prior experience with highly automated claim adjudication systems.

Responsibilities

• Create the blueprint for configuration of the plan from plan documents and/or plan standards.
• Build, validate and test medical and dental plan benefits and associated code mapping logic.
• Make necessary plan building and logic revisions when plans are amended.

Skills

Claims adjudication

Plan interpretation

Automated adjudication systems

Job description

• Create the blueprint for configuration of the plan from plan documents and/or plan standards.
• Build, validate and test medical and dental plan benefits and associated code mapping logic.
• Make necessary plan building and logic revisions when plans are amended.

Qualifications:

• Knowledge of professional and institutional claims adjudication.
• Ability to interpret plan documents and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes.
• Prior experience with a highly automated and integrated claim adjudication systems.

About the Role:

• This position is remote or hybrid, with an ideal candidate assigned to the Buffalo Office.
• You will work with department managers and team leaders to improve efficiency within the company.
• You will maintain the claim system Plan Building mailbox to research and resolve system issues.

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Backed by leading healthcare and technology investors, the company is headquartered in Buffalo, NY and values resilience, uncommon thinking, and positivity.