Health Plan Implementation Auditor

pofft Technology Inc.; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

pofft Technology Inc. is hiring an Implementation Auditor in the United States. The role involves in-depth plan coding and testing of health insurance plans underwritten by WGAT and PCMI, ensuring compliance with employer summary plan descriptions.

The position reports to the Supervisor, Benefit Installation & Distribution and emphasizes accuracy in claim payments and robust testing of new plans. The candidate will verify plans against summaries, test plans before production, work with

Qualifications

• BS/BA degree in Business or related field and a minimum of three (3) to five (5) years of recent experience as a medical/dental claims auditor or plan testing experience.
• Exceptional understanding and ability to interpret summary plan descriptions of employee medical/dental benefits.
• Strong ability to work efficiently and effectively in a multi-task, multi-project environment.

Responsibilities

• Testing: verify new and existing plans loaded on the Company’s claim management system against the relevant Summary Plan Description to ensure accuracy of claims payments.
• Test all new plans prior to loading into production (medical, dental and vision).
• Collaborate with programmers to test claims and related system programs to verify impact within the HCPS.
• Conduct system analysis and testing of mass system updates.
• Plan coding of new business and plan changes for medical, dental, and vision plans.
• Communicate with other operational departments to ensure smooth integration of new plans for WGAT and PCMI moving into production.

Education

Bachelor's degree in Business or related field

Job description

pofft Technology Inc. is hiring an Implementation Auditor in the United States. The role involves in-depth plan coding and testing of health insurance plans underwritten by WGAT and PCMI, ensuring compliance with employer summary plan descriptions.

The position reports to the Supervisor, Benefit Installation & Distribution and emphasizes accuracy in claim payments and robust testing of new plans. The candidate will verify plans against summaries, test plans before production, work with