Hybrid Benefit Operations Specialist – Healthcare Benefits

Capital Rx; Denver (CO); Hybrid; USD 85.000 - 90.000; Vollzeit

Zusammenfassung

Judi Health is seeking a Benefit Operations Specialist to configure medical and pharmacy benefits, run claims testing, and ensure QA across implementations. You will work with product/dev teams to tailor plans, communicate complex configurations to clients, and drive process improvements for efficient benefit delivery.

The role offers hybrid work in multiple US locations and opportunities to influence best practices within integrated benefits.

Qualifikationen

• Bachelor's degree preferred.
• 3+ years of TPA/health plan experience in Medical Benefit configuration, testing, and claims monitoring.
• Experience with Cigna or Aetna preferred.
• Pharmacy, Dental, or Vision experience a plus.
• Self-funded plans, Medicare/Government programs and ERISA experience preferred.
• Attention to detail with ability to manage priorities in a fast-paced environment.
• Excellent written and verbal communication skills.
• Experience working with product/dev teams and familiarity with Agile preferred.
• Proficiency with Excel, SQL, and data visualization tools is a plus.

Aufgaben

• Configure benefits including new plan setup and changes, perform claims testing and audits.
• Collaborate with product/dev and other teams to tailor plans for client requests.
• Explain benefit configuration and testing processes clearly to clients.
• Recommend process improvements to increase efficiency and quality.
• Work cross-functionally to create new benefit options aligned with market needs, including government programs.
• Develop standard testing scenarios and validate test claims against benefit designs.
• Create training materials and provide education for cross-functional teams.
• Maintain SLA performance and quality levels in production.
• Participate in client meetings to align Judi logic with client needs.
• Partner with leadership to design benefit plans meeting regulatory and client requirements.
• Assist Client Services during live deployments and troubleshoot discrepancies.
• Support general business or team needs as assigned.

Kenntnisse

TPA experience

Benefit configuration

Claims monitoring

SPD creation

Medical Coding

Cigna/Aetna experience

Pharmacy/Dental/Vision exp

Self-funded/Medicare/ERISA

Attention to detail

Verbal/Written communication

Agile experience

Excel

SQL

Data visualization

Ausbildung

Bachelor's degree

Tools

Excel

Jobbeschreibung

Judi Health is seeking a Benefit Operations Specialist to configure medical and pharmacy benefits, run claims testing, and ensure QA across implementations. You will work with product/dev teams to tailor plans, communicate complex configurations to clients, and drive process improvements for efficient benefit delivery.

The role offers hybrid work in multiple US locations and opportunities to influence best practices within integrated benefits.