Benefits Plan Configurator I

Western Growers Health; Irvine (CA); On-site; USD 75,000 - 110,000; Full time

Job summary

Western Growers Health is seeking a Benefits Configuration Analyst to assist with building, testing, auditing, and maintaining medical, dental, pharmacy, vision, and ancillary benefit plans for employer groups. You will translate SPD provisions into claims system configurations and ensure accuracy across configurations and plan administration.

This role develops proficiency in benefit interpretation, system configuration, QA testing, and claim adjudication under senior guidance, collaborating

Qualifications

• BS/BA degree in Business, Computer Science, HealthCare Administration, or related field preferred. Minimum two (2) years of experience in health plan coding, benefit configuration, claims auditing, plan testing, or related health plan administration.
• Ability to interpret SPDs, Plan Documents, amendments and benefit summaries with guidance.
• Strong analytical skills with ability to identify discrepancies and research solutions.

Responsibilities

• Builds and configures medical, dental, pharmacy, vision and ancillary benefits in the claims system.
• Review SPDs and Plan Documents to translate plan provisions into configurations.
• Perform testing of benefit configurations and verify against SPDs and amendments.
• Identify and document configuration discrepancies and assist with issue resolution.
• Maintain documentation of configurations and testing results.
• Collaborate with internal teams to ensure accurate benefit implementation.

Skills

Analytical skills

Attention to detail

Communication skills

Microsoft Excel

Education

BS/BA degree in Business, Computer Science, HealthCare Administration, or related field preferred (minimum 2 years in health plan coding, benefit configuration, claims auditing, plan testing)

Tools

Microsoft Word

Microsoft Office

Job description

Western Growers Health is seeking a Benefits Configuration Analyst to assist with building, testing, auditing, and maintaining medical, dental, pharmacy, vision, and ancillary benefit plans for employer groups. You will translate SPD provisions into claims system configurations and ensure accuracy across configurations and plan administration.

This role develops proficiency in benefit interpretation, system configuration, QA testing, and claim adjudication under senior guidance, collaborating