Benefit Plan Configuration Specialist

We exist for workers and their employers -- who are the backbone of our economy.  That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

Summary of role:

As a Benefits Plan Configuration Specialist, you will focus on understanding, translating, and configuring medical and dental plan designs into the core claims platform to ensure accurate processing of claims. You will maximize effectiveness of the core claims platform by continuously evaluating current processes and business needs along with system capabilities. You will create logic sets, based on code mapping, with an emphasis on accuracy and proficiency.

Responsibilities Include:

• 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 “work around” 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.

Qualifications:

Required Skills and Abilities:

• Knowledge of professional and institutional claims adjudication.

• Ability to interpret plan documents and amendments and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes.