Health Plan Configuration Specialist

Relation-Insurance-Services; Tulsa (OK); On-site; USD 62,000 - 107,000; Full time

Benefits offered by this job

Competitive pay

Health and wellness benefits

401K

Paid time off

Job summary

Relation Insurance Inc. is seeking a Configuration Specialist to configure and maintain health benefit plans in our TPA claims system.

The role involves building deductibles, copays, and benefit provisions, validating configurations against plans and client requirements, and coordinating QA and testing with internal teams. The ideal candidate has 2+ years in health benefits administration and familiarity with HIPAA claims standards, with proficiency in Microsoft Office and strong analytical

Qualifications

• Minimum two years of experience in health benefit administration, medical claims processing, plan configuration, or related healthcare benefits function.
• Experience configuring health benefit plans within a TPA, self-funded health plan, payer or health plan environment preferred.
• Familiarity with healthcare coding, HIPAA-related claims standards, or other system rules used in medical claims adjudication preferred.

Responsibilities

• Configures health benefit plans in the claims administration system based on approved plan documents, benefit summaries, and client requirements.
• Builds deductibles, out-of-pocket maximums, copays, coinsurance, benefit limits and exclusions within the claims system.
• Validates configured benefits against approved plan documents and client requirements.
• Develops and executes claim test scenarios to verify benefit calculations and claims processing.

Skills

Analytical thinking

Problem solving

Microsoft Office

Communication skills

Education

High school diploma or equivalent

Degree in business/healthcare/IS

Job description

Relation Insurance Inc. is seeking a Configuration Specialist to configure and maintain health benefit plans in our TPA claims system.

The role involves building deductibles, copays, and benefit provisions, validating configurations against plans and client requirements, and coordinating QA and testing with internal teams. The ideal candidate has 2+ years in health benefits administration and familiarity with HIPAA claims standards, with proficiency in Microsoft Office and strong analytical