Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, creates continuous learning and embraces the ideas and diversity of others.
As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.
Position Summary:
The Benefit Plan Configurator reports to the Benefits Plan Configuration Director. This position will be responsible for the oversight of design, development, testing, deployment, and documentation of plan/benefit designs for new and existing business. This position will build the plan design within the claim adjudication system using knowledge of benefit design, and data elements. Additionally, the BPA will collaborate and work with the Account Management Division regarding implementation, set up and maintenance resulting in assured adherence to desired formulary goals for Consociate Health clients.
Essential Duties and Responsibilities:
Builds and maintains plan/benefit design rules and limitations to include:
- Implementation of adjudication rules
- Implementation of clinical rules for prior authorization and formulary management
- Claim testing to ensure accurate claim adjudication
- Client management
- Plan/group management
Acts as liaison between client and internal stakeholders and claims adjudication vendor to coordinate receipt of required information for claims adjudication system set up, reporting and claim adjudication process. This includes the following tasks:
- Attends implementation meetings to discuss technical requirements and protocols.
- Maintains published timelines for receiving and processing client data and communicates targets to staff and clients. Coordinates with client to ensure the timely receipt and processing of scheduled data.
- Develops, maintains, and formats client data fields and reporting requirements.
- Analyzes reports to research and resolve discrepancies, errors, and problems.
- Troubleshoots issues from client and internal departments that interrelate with claims data submission and processing.
- Serves as liaison between client technical team and claims adjudication vendor for both routine work and special projects.
- Evaluates processed claims, identifies errors and makes adjustments accordingly.
- Creates and maintains plan/benefit design documentation for all contracts/solutions.
- Works collaboratively with all staff to ensure effective communication and acts as a resource in support of the claim’s adjudication process, (plan/benefit set up).
- Interacts with IT to coordinate plan/benefit design changes.
- Recommends new and enhanced system logic to support plan/benefit design.
- Makes recommendations to streamline the work processes, create efficiency and assist with updates.
- Research plan/benefit design options and requirements as required.
- Provides optimum client service.
Benefits:
- Paid time off
- Paid Holidays
- Medical, Dental and Vision Insurance
- Basic Group Life, Short Term and Long Term Disability
- Voluntary Life, Critical Illness and Accident Coverage
- 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.
Knowledge, Skill and Abilities:
- Experience working with internal and external client personnel.
- Advanced use of Microsoft Office Products (ex. Excel skills: V-lookups, formulas, ability to create, edit and run reports).
- Experience in use of claims adjudication system for plan/benefit design.
- Program/project management experience preferred.
- A.A. degree or higher desired.
General Expectations:
- Present a positive image of Consociate at all time.
- Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a client, co-worker, or supervisor.
- Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
- Identify and perform work that has not been specifically assigned, as needed.
- Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.
- Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
- Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Administration Division.
- Attend required in-service and staff meetings.
- Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.