• Plan Builder/ Systems Specialist

    Job Location(s) US-NV-Las Vegas | US-IA-West Des Moines
    Job ID
    # of Openings
    Benefits Administration
    Job Type
    Regular Full-Time
  • Overview


    The Plan Builder/ Systems Specialist is responsible for ensuring accurate and timely implementation and ongoing building of benefit plans into the Claims system; serves as a credible and reliable source of reference to the organization regarding benefit plan building and design, to ensure timely and accurate benefit applications and processing.




    • Implementation of Benefit Plans into system through targted building plan procedures
    • Revision of benefit plan design as needed to update for Client changes and ensure accurate and consistent benefit design within the organizational network
    • Ongoing testing of benefit plan designs to ensure accuracy within the system
    • EDI import and Auto Adjudication.
    • Works closely with Auditor and Trainer to facilitate benefit processes
    • Assists in identifying issues outside of the scope of plan building (nuances of plan and uses a proactive approach to facilitate the claims and member services process
    • Reviews completed plan building with department supervisor
    • Provides assistance to client base to resolve benefit plan design issues
    • Prioritizes assignments to ensure timely implementation of benefit plans





    Associates Degree preferred (high school diploma required) plus work experience in a similar industry preferred, or a combination of relevant skills and experience


    Knowledge, Skills and Abilities:    


    • A minimum of 3 years Managed Care/Health Plan experience in claims processing and/or member service capacity required
    • A minimum of 3 years of experience interpreting benefit plan design and summary plan descriptions required
    • Excellent knowledge of claims systems required
    • ICD-9/ICD-10, CPT coding and medical terminology required
    • Proficient in MS Word and Excel and have strong analytical skills
    • Familiarity with EDI import and Auto Adjudication.


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