Plan Build & System Configuration Lead

Point C; United States; Remote; USD 55,000 - 63,000; Full time

Benefits offered by this job

Comprehensive medical, dental, vision,

401(k) retirement plan with employer-

Health Savings Account (HSA) & FSAs

Paid time off (PTO) and disability

Employee Assistance Program (EAP)

Job summary

Point C Health seeks a skilled professional to optimize auto adjudication by building and configuring healthcare plan designs and testing configurations across multiple systems. The role emphasizes accuracy, regulatory compliance, and collaboration with IT and stakeholders.

You will develop and maintain plan configurations, review changes in healthcare policies, and test updates to ensure efficient claims adjudication while supporting multiple systems and clients.

Qualifications

• Associate’s degree in healthcare administration, information systems, or a related field.
• Minimum of 2 years of experience in plan building, system configuration, and claims adjudication in the healthcare industry.
• Certification in healthcare information systems or related fields preferred.

Responsibilities

• Develop, configure, and maintain healthcare plan designs and benefit configurations in various systems.
• Ensure all plan configurations support auto adjudication and meet regulatory and compliance requirements.
• Regularly review and update plan configurations to reflect changes in healthcare policies and regulations.
• Oversee the integration and interoperability of different healthcare systems to streamline auto adjudication processes.
• Facilitate system upgrades, patches, and maintenance to ensure seamless operation and minimal downtime.
• Collaborate with IT and other departments to implement new technologies and enhancements.
• Perform comprehensive testing of plan configurations to ensure accurate and efficient claims adjudication.
• Identify and resolve any discrepancies or issues in the adjudication process.
• Create and document testing protocols and procedures to maintain high standards of quality and accuracy.
• Work closely with internal and external stakeholders to gather requirements and ensure plan configurations meet organizational and client needs.
• Become a subject matter expert on plan building and system configuration, providing guidance and support to other departments.
• Communicate effectively with stakeholders to keep them informed of project status, issues, and resolutions.
• Maintain detailed documentation of all plan configurations, system changes, and testing procedures.
• Use data and analytics to identify trends, opportunities for improvement, and areas needing attention.

Skills

Plan building

System configuration

Claims testing

Education

Healthcare administration

Information systems

Tools

Healthcare management systems

Job description

Point C Health seeks a skilled professional to optimize auto adjudication by building and configuring healthcare plan designs and testing configurations across multiple systems. The role emphasizes accuracy, regulatory compliance, and collaboration with IT and stakeholders.

You will develop and maintain plan configurations, review changes in healthcare policies, and test updates to ensure efficient claims adjudication while supporting multiple systems and clients.