Plan Benefit Analyst

Reflect Health; Cincinnati (OH); On-site; USD 32,000 - 40,000; Full time

Job summary

Reflect Health in Mason, OH, seeks a Plan Benefit Analyst to analyze health and welfare plans, review SPDs and benefit documents, and ensure accurate reflection in claims systems. This role focuses on benefit design, configuration, and client support.

You will collaborate with Claims, Plan Build, Compliance, and Product teams, research complex benefit questions, validate configurations, and participate in testing and implementation of new plans.

Qualifications

• Experience reading and interpreting benefit plan documents, SPDs, and related materials.
• Ability to analyze medical, dental, vision, and other plan designs and requirements.
• Strong research skills to resolve benefit questions and discrepancies.
• Experience with claims/benefits systems and administration processes is preferred.
• Attention to HIPAA and confidentiality in handling plan data.
• Excellent communication skills for internal teams and clients.

Responsibilities

• Benefit Plan Analysis: Review designs and requirements to understand administration.
• Plan Document Interpretation: Read SPDs and benefit summaries to interpret provisions.
• Benefit Research: Investigate eligibility, coverage, deductibles, coinsurance, and accumulators.
• Claims Support: Research issues to ensure alignment with plan provisions.
• System Validation: Work with Plan Build to ensure configurations reflect documents.
• Benefit Configuration Support: Translate requirements into system specifications.

Skills

Benefits Experience

Plan Interpretation

Analytical Skills

Benefit Knowledge

Claims Knowledge

Systems Experience

Attention to Detail

Communication

Organization

Technology

Adaptability

Confidentiality

Collaboration

Tools

Excel

Word

Data reporting tools

Job description

Reflect Healthis the evolution of S&S Health, a trusted independent third-party administrator founded in 1994 to meet the growing need for access, simplified connectivity, and benefits administration. Headquartered in Mason, OH, we have built a reputation based on innovation, service excellence, and a deep understanding of how to drive better outcomes at lower cost. Over the years, we grew into a national presence serving employers, TPAs, health systems, and benefit consultants across all 50 states. We developed proprietary claims technology, expanded our offerings to include level-funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members.

Position Summary

The Plan Benefit Analyst is responsible for analyzing, interpreting, and supporting the administration of health and welfare benefit plans. This role reviews plan documents, benefit specifications, and related materials to understand how benefits are intended to operate and helps ensure those provisions are accurately reflected in claims administration systems and business processes.

The Plan Benefit Analyst works closely with internal teams to research benefit questions, interpret plan provisions, validate benefit configurations, investigate claims-related issues, and support the implementation and maintenance of client benefit plans. The role requires strong analytical and problem-solving skills, attention to detail, and the ability to translate complex benefit information into clear and practical solutions.

This position does not involve software programming or coding. It requires the ability to understand benefit plan design, identify how plan provisions should be administered, and work effectively with systems and business partners to support accurate benefit administration.

Responsibilities

• Benefit Plan Analysis:Review and analyze medical, dental, vision, and other benefit plan designs, specifications, and requirements to understand how benefits should be administered.
• Plan Document Interpretation:Review Summary Plan Descriptions (SPDs), plan documents, benefit summaries, amendments, and other supporting documentation and interpret applicable plan provisions.
• Benefit Research:Research complex benefit questions involving eligibility, coverage, limitations, exclusions, deductibles, coinsurance, out-of-pocket requirements, accumulators, and other plan provisions.
• Claims Support:Research claims and benefit-related issues to determine whether claims have been administered consistently with applicable plan provisions and identify potential discrepancies.
• System Validation:Work with Plan Build and other system teams to validate that benefit plan configurations accurately reflect plan documents and specifications.
• Benefit Configuration Support:Translate benefit plan requirements into clear specifications and provide guidance regarding how plan provisions should be represented within claims administration systems. This role does not involve software coding.
• Testing & Validation:Participate in testing of new and modified benefit plans, review test results, identify discrepancies, and work with appropriate teams to resolve issues before implementation.
• Issue Resolution:Investigate complex benefit and administration issues, identify root causes, and recommend appropriate resolutions based on plan provisions, business requirements, and established processes.
• Cross-Functional Support:Collaborate with Claims, Plan Build, Client Services, Eligibility, Product Development, Compliance, and other internal teams on benefit-related questions and initiatives.
• Product Support:Support Product Development and other internal teams by analyzing benefit requirements and identifying the operational and administrative considerations associated with new or enhanced products.
• Client Support:Assist with client-related benefit questions and requests as directed, providing clear and accurate information based on applicable plan documentation and established processes.
• Regulatory Awareness:Maintain working knowledge of applicable employee benefits requirements, including HIPAA, the Affordable Care Act, and other regulations relevant to benefit administration.
• Documentation:Maintain accurate documentation of benefit interpretations, research findings, testing results, and other information necessary to support consistent administration.
• Process Improvement:Identify opportunities to improve benefit analysis, documentation, testing, and administration processes to increase accuracy, efficiency, and consistency.
• Project & Work Management:Manage multiple benefit-related requests and priorities, track assignments and deadlines, and communicate status, issues, and expected completion timelines to appropriate stakeholders.
• Additional Responsibilities:Perform other duties and responsibilities as assigned.

Qualifications

• Benefits Experience:Previous experience in employee benefits, health plan administration, claims administration, benefits consulting, or a related field.
• Plan Interpretation:Ability to read, understand, and interpret benefit plan documents, SPDs, benefit summaries, and related materials.
• Analytical Skills:Strong analytical, mathematical, critical-thinking, and problem-solving skills, with the ability to research complex questions and determine appropriate solutions.
• Benefit Knowledge:Understanding of common health plan concepts, including deductibles, coinsurance, copayments, out-of-pocket maximums, eligibility, exclusions, limitations, accumulators, and network benefits.
• Claims Knowledge:Familiarity with health insurance claims and the relationship between plan provisions and claims administration preferred.
• Systems Experience:Experience working with claims administration, benefits administration, or other healthcare/benefits systems preferred.
• Attention to Detail:Highly organized and detail-oriented, with a strong focus on accuracy, consistency, and quality.
• Communication:Excellent verbal and written communication skills, with the ability to explain complex benefit concepts clearly and professionally to internal teams and, when appropriate, clients.
• Organization:Ability to prioritize and manage multiple requests, projects, and deadlines simultaneously.
• Technology:Proficiency with Microsoft Office, particularly Excel and Word; experience working with data, spreadsheets, or reporting tools preferred.
• Adaptability:Ability to learn new systems, processes, products, and benefit designs and adapt effectively to changing priorities.
• Confidentiality:Demonstrated ability to protect confidential and sensitive information, including employee and member information.
• Collaboration:Ability to work effectively and professionally with coworkers, clients, and business partners while maintaining a respectful and team-oriented approach.

Compensation

$23.00–$29.00 per hour, commensurate with experience, qualifications, and internal equity.

Reflect Health is committed to providing a safe and secure workplace for all employees. Please note that all final candidates will undergo a comprehensive background check and drug testing as part of our hiring process.