Plan Benefit Analyst
S&S Health is a premier healthcare administration company located in Cincinnati, Ohio.
We offer self, level and fully funded solutions that lower costs while improving outcomes with a consumer centric experience.
Our integrated benefits, services and technology platform have been developed to serve the needs of Employers, TPAs, and Health Systems.
The company has a nationwide presence with the ability to sell and service in every state.
The Plan Benefit Analyst builds medical, dental, vision, and other employee benefit plans of clients into claims processing system.
Candidate is responsible for building and maintaining the logic in the claim system that drives accurate and appropriate claims adjudication.
Essential Functions:
System configuration of medical, dental, vision, and other benefit plans into claim system to accurately adjudicate benefits.
Includes initial build and subsequent modifications.
Configuration is limited to utilization of logic-based modules embedded in claim system; does not include actual coding.
Verification of configuration output and collaboration with internal divisions for completion of review and testing.
Receives, researches and responds to technical inquiries related to system configuration.
Examples:
provider contracts, claims, and plan benefits.
Tracking and communication of status of configuration activity.
Ensures the financial accuracy of claims payment.
Review of Summary Plan Descriptions and other documents supporting system configuration with appropriate team members.
Working knowledge of benefit related regulation, including but not limited to, HIPAA and Affordable Care Act laws.
Acts as an advisor to product development regarding system configuration necessary to implement and execute innovative products.
Practice root cause analysis to better overall processes, implications and problem resolution.
All other duties as assigned.
Minimum
Qualifications:
Critical thinking and problem-solving skills a must.
Background in employee benefits and claim administration.
Strong ability to comprehend benefit plan documentation and interpret/apply/convert information into system configuration and logic.
Comprehensive math and analytical skills.
Excellent verbal and written communication skills.
Must be able to effectively communicate clearly and concisely, orally and in writing, with the staff and, in certain circumstances, clients.
Must be able to read, write, speak and understand the English language.
Ability to prioritize and simultaneously manage multiple projects.
Organizational and detail-oriented skills required.
Previous experience with claim administration systems Excel, Word, Microsoft Office and similar program experience.
A team player, flexible in the context of change.
Able to protect confidential information.
Must work harmoniously with other personnel and maintain a professional and respectful decorum in all situations dealing with co-workers, clients and other entities.
EDUCATION/EXPERIENCE High School diploma or GED with experience in medical benefits or managed care.
Post high school education is preferred.
Prefer 1-3 years' experience in healthcare in employee benefits (i.
e.
medical, dental, vision, tax advantage, etc.
) or claim administration.
An equivalent combination of education, training, or work experience which demonstrates the ability to perform the duties of this position.
Prefer experience and knowledge of working with Boolean Logic.
WORKING CONDITIONS Remote work environment will be secure, quiet, distraction free, dedicated work area.
Requires accommodations to allow for focus on work Is subject to frequent interruptions.
May be subject to work beyond normal working hours such as weekends and holidays when necessary.
S&S if very sensitive to any such exceptions and keeps them to a minimum.
Attends and participates in continuing educational programs designed to maintain position requirements.
Employees are responsible for maintaining the work area in a safe, secure, and non-hazardous condition at all times.
Employee will maintain security devices and procedures necessary to prevent use by unauthorized persons, including by preventing the connection of any Company-furnished computer system, network or database to any computer, network, or database other than a computer, network, or database to which connections are provided or authorized by the Company.
Recommended Skills Administration Analytical Attention To Detail Boolean Algebra Claim Processing Communication Estimated Salary: $20 to $28 per hour based on qualifications.
We offer self, level and fully funded solutions that lower costs while improving outcomes with a consumer centric experience.
Our integrated benefits, services and technology platform have been developed to serve the needs of Employers, TPAs, and Health Systems.
The company has a nationwide presence with the ability to sell and service in every state.
The Plan Benefit Analyst builds medical, dental, vision, and other employee benefit plans of clients into claims processing system.
Candidate is responsible for building and maintaining the logic in the claim system that drives accurate and appropriate claims adjudication.
Essential Functions:
System configuration of medical, dental, vision, and other benefit plans into claim system to accurately adjudicate benefits.
Includes initial build and subsequent modifications.
Configuration is limited to utilization of logic-based modules embedded in claim system; does not include actual coding.
Verification of configuration output and collaboration with internal divisions for completion of review and testing.
Receives, researches and responds to technical inquiries related to system configuration.
Examples:
provider contracts, claims, and plan benefits.
Tracking and communication of status of configuration activity.
Ensures the financial accuracy of claims payment.
Review of Summary Plan Descriptions and other documents supporting system configuration with appropriate team members.
Working knowledge of benefit related regulation, including but not limited to, HIPAA and Affordable Care Act laws.
Acts as an advisor to product development regarding system configuration necessary to implement and execute innovative products.
Practice root cause analysis to better overall processes, implications and problem resolution.
All other duties as assigned.
Minimum
Qualifications:
Critical thinking and problem-solving skills a must.
Background in employee benefits and claim administration.
Strong ability to comprehend benefit plan documentation and interpret/apply/convert information into system configuration and logic.
Comprehensive math and analytical skills.
Excellent verbal and written communication skills.
Must be able to effectively communicate clearly and concisely, orally and in writing, with the staff and, in certain circumstances, clients.
Must be able to read, write, speak and understand the English language.
Ability to prioritize and simultaneously manage multiple projects.
Organizational and detail-oriented skills required.
Previous experience with claim administration systems Excel, Word, Microsoft Office and similar program experience.
A team player, flexible in the context of change.
Able to protect confidential information.
Must work harmoniously with other personnel and maintain a professional and respectful decorum in all situations dealing with co-workers, clients and other entities.
EDUCATION/EXPERIENCE High School diploma or GED with experience in medical benefits or managed care.
Post high school education is preferred.
Prefer 1-3 years' experience in healthcare in employee benefits (i.
e.
medical, dental, vision, tax advantage, etc.
) or claim administration.
An equivalent combination of education, training, or work experience which demonstrates the ability to perform the duties of this position.
Prefer experience and knowledge of working with Boolean Logic.
WORKING CONDITIONS Remote work environment will be secure, quiet, distraction free, dedicated work area.
Requires accommodations to allow for focus on work Is subject to frequent interruptions.
May be subject to work beyond normal working hours such as weekends and holidays when necessary.
S&S if very sensitive to any such exceptions and keeps them to a minimum.
Attends and participates in continuing educational programs designed to maintain position requirements.
Employees are responsible for maintaining the work area in a safe, secure, and non-hazardous condition at all times.
Employee will maintain security devices and procedures necessary to prevent use by unauthorized persons, including by preventing the connection of any Company-furnished computer system, network or database to any computer, network, or database other than a computer, network, or database to which connections are provided or authorized by the Company.
Recommended Skills Administration Analytical Attention To Detail Boolean Algebra Claim Processing Communication Estimated Salary: $20 to $28 per hour based on qualifications.
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