Remote Benefit Plan Configurator I

Wg Health; Irvine (CA); Hybrid; USD 31,000 - 40,000; Full time

Job summary

WG Health is hiring a Benefit Plan Builder who will develop and configure medical, dental, pharmacy, vision, and ancillary benefits within the claims administration system. The role translates SPD provisions into precise system configurations and executes testing to ensure accuracy.

The position requires reviewing SPDs and documents, performing audits, and collaborating with Claims Examiners and internal teams to resolve discrepancies, ensuring compliant plan administration.

Qualifications

• Minimum two years of experience in health plan coding, benefit configuration, claims auditing, or related health plan administration.
• Ability to interpret Summary Plan Descriptions (SPDs), Plan Documents, amendments and benefit summaries.
• Strong written and verbal communication skills.

Responsibilities

• Build and configure benefit plans in the claims administration system according to guidelines.
• Review SPDs and Plan Documents to translate provisions into system configuration.
• Perform testing and auditing of benefit configurations and collaborate with internal stakeholders.
• Escalate complex issues to senior team members and document results.

Skills

Analytical skills

Attention to detail

Communication skills

Education

BS/BA degree in Business or Healthcare Administration

Tools

Microsoft Excel

Microsoft Word

Job description

WG Health is hiring a Benefit Plan Builder who will develop and configure medical, dental, pharmacy, vision, and ancillary benefits within the claims administration system. The role translates SPD provisions into precise system configurations and executes testing to ensure accuracy.

The position requires reviewing SPDs and documents, performing audits, and collaborating with Claims Examiners and internal teams to resolve discrepancies, ensuring compliant plan administration.