Remote Benefits Plan Architect

Centivo; Buffalo (NY); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Centivo is seeking a Benefits Plan Configuration Specialist to translate and configure medical and dental plan designs into our core claims platform, ensuring accurate processing of claims. You will map code sets, create configuration logic, and continuously evaluate processes to improve efficiency and accuracy.

The role requires interpreting plan documents, testing plan benefits, and collaborating across teams to implement changes on time.

Qualifications

• Prior experience with a highly automated and integrated claim adjudication systems.
• Ability to interpret plan documents and amendments and translate benefits to ICD-10, HCPCS, CPT, CDT and other insurance billing codes.
• Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.
• Ability to adapt to a constantly changing environment.
• Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions.
• Demonstrated ability to work in a fast-paced, agile environment managing multiple issues with pressure of production schedules and deadlines.
• Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.
• Proficiency in Microsoft Office applications and other web-based software applications.
• Ability to learn new proprietary computer systems.

Responsibilities

• Create the blueprint for configuration of the plan from plan documents and/or plan standards.
• Build, validate and test medical and dental plan benefits and associated code mapping logic.
• Make necessary plan building and logic revisions when plans are amended.
• Build auto-adjudication logic and test for integration with plan.
• Resolve system issues and act as contact for opening and closing jobs on the core claims platform job list.
• Test open jobs on new releases from the core claims platform and troubleshoot problems prior to loading into production.
• Troubleshoot system problems, develop resolutions and/or workaround procedures.
• Work with Department Managers, Team Leaders, and other applicable personnel to improve efficiency within the company.
• Coordinates the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
• Communicate changes to other departments and help with any required training necessary because of system changes.
• Maintain the claim system Plan Building mailbox to research and resolve system issues.

Skills

Claims adjudication knowledge

Plan documents interpretation

Customer service

Adaptability

Organizational skills

Agile environment experience

Cross-team collaboration

MS Office proficiency

Learn new systems

Education

Associates or Bachelor’s degree preferred

Tools

Microsoft Office

Job description

Centivo is seeking a Benefits Plan Configuration Specialist to translate and configure medical and dental plan designs into our core claims platform, ensuring accurate processing of claims. You will map code sets, create configuration logic, and continuously evaluate processes to improve efficiency and accuracy.

The role requires interpreting plan documents, testing plan benefits, and collaborating across teams to implement changes on time.