Health Benefits Configuration Specialist

Edison Health Solutions, LLC; Oklahoma; On-site; USD 62,000 - 107,000; Full time

Benefits offered by this job

Competitive pay

401K

Employee assistance programs

Paid time off

Paid holidays

Job summary

Relation Insurance Services is seeking a Configuration Specialist to configure and maintain health benefit plans within our TPA claims administration system. You will build deductibles, out-of-pocket maximums, copays, coinsurance, and exclusions to support accurate claims processing.

You will also configure networks, fee schedules, reimbursement arrangements, and system rules, maintain configurations for renewals, and review plan documents for missing or conflicting information before

Qualifications

• High school diploma or equivalent required.
• 2–4 year degree in business, healthcare administration, information systems, or related field preferred.
• Experience with health benefit administration and claims processing is advantageous.
• Ability to interpret plan documents and translate into system configurations.

Responsibilities

• Configure and maintain health benefit plans in the claims system using approved documents and client requirements.
• Build deductibles, out-of-pocket maximums, copays, and exclusions for accurate adjudication.
• Configure networks, fee schedules, and benefit codes to support processing.
• Review plan documents for missing or conflicting information before configuration.
• Develop and execute benefit configuration testing and document results.

Skills

Attention to detail

Analytical thinking

Problem solving

Communication

Education

High school diploma

Bachelors in business or healthcare

Tools

TPA claims system

Microsoft Office

Job description

Relation Insurance Services is seeking a Configuration Specialist to configure and maintain health benefit plans within our TPA claims administration system. You will build deductibles, out-of-pocket maximums, copays, coinsurance, and exclusions to support accurate claims processing.

You will also configure networks, fee schedules, reimbursement arrangements, and system rules, maintain configurations for renewals, and review plan documents for missing or conflicting information before