Managed Care Benefit Configuration Specialist

CommonSpirit Health; Bakersfield (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

CommonSpirit Health is seeking a Managed Care Benefit Configuration Specialist to implement and maintain client benefit setups. This remote position requires experience in benefits configuration and a commitment to quality assurance. With a competitive pay range and a comprehensive benefits package, this role is vital for ensuring the accurate configuration of health plan benefits.

Benefits

Flexible Health & Welfare benefits package

Paid Time Off and Sick Leave

401k retirement plan with employer-match

Qualifications

• 3+ years experience with benefits configuration or setup required.
• Associate's degree or equivalent experience is necessary.
• Bachelor's degree preferred.

Responsibilities

• Implement new client benefit setups and configurations.
• Audit and monitor client setups for accuracy.
• Ensure compliance with policies and procedures.

Skills

Benefits configuration

Quality assurance monitoring

Client setup auditing

Education

Associate's degree

Bachelor's degree

Tools

Managed care platforms (e.g., EZCAP, QNXT, HealthEdge)

Job description

Managed Care Benefit Configuration Specialist

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Managed Care Benefit Configuration Specialist

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• This position is remote, but will be expected to work PST business hours (8am-5pm PST).*
  
  

*Responsibilities*

• This position is remote, but will be expected to work PST business hours (8am-5pm PST).*
  
  

Position Summary

The Benefit Configuration Specialist will implement new client benefit setup and hierarchy based on the specific needs of the customer. Benefit setup based on plan design changes of existing customers. Configures all aspects of benefit plan per health plan utilizing the Financial Risk Matrix for major commercial, Medicare Advantage and Medicaid Health Plans. Create and maintain configuration templates when loading benefit information.

Responsibilities May Include

• Develop all hierarchy levels in managed care platform for customer setups and configuration
• Review and verify client setup is accurately reflected in platform
• Monitor as assigned all QA processes for benefit builds
• Follow and adhere to all Policies and Procedures for the benefit workflow within the managed care platform
• Support quality reviews and testing of all benefit setup prior to customer implementation and go-live date
• Ensure health plan configuration within system templates, related plans and benefits are updated as needed as well as tested and audited if issues are found in Benefit Configuration
• Partner with Compliance department to audit client setups and configuration post go-live
• Resolve escalated and complex processing, change requests, issues or questions
  
  

*Qualifications*

Minimum Qualifications

• 3+ years experience with benefits configuration, set up, or implementation
• Associate's degree or equivalent experience
  
  

Preferred Qualifications

• Healthcare or pharmacy benefit management industry preferred
• Previous managed care platform working knowledge (ie: EZCAP, QNXT, HealthEdge) preferred
• Bachelor’s degree preferred
  
  

*Overview*

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

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*Pay Range*

$25.25 - $36.61 /hour

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Wellness and Fitness Services, Hospitals and Health Care, and Medical Practices

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