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Healthcare Management Administrators · 3 months ago

Health Plan Configuration Analyst II

Bellevue, WA

Full-time

Hybrid

Mid Level

$108K/yr - $120K/yr

3+ years exp

Healthcare Management Administrators (HMA) is a premier third-party health plan administrator focused on providing customized health plans for medium to large-size employers. The Health Plan Configuration Analyst II role is responsible for implementing and programming client benefit plans, ensuring accurate benefits programming, and managing vendor files to facilitate non-standard benefits for select groups.

Health CareInsurance

Responsibilities

Review prior SPD's and make recommendations for new group implementations, such as system capabilities and regulatory requirements, and present to new clients as needed. Ask clarifying questions about plan details that could be missing

Create and update plan summaries and program the claims system for simple and medium complexity client renewals and implementation of off-cycle benefit changes

With the assistance of the Plan Building Specialist II or III, assist with programming updates for clients with complex renewals

Assist with complex and escalated customer service issues to ensure resolution

Maintaining the vendor file maintenance for buy-up products. This includes incoming/outgoing files, setting up SFRP and retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups

Work with vendor to ensure accurate EOB design and setup as needed

Review and respond to applicable TechOps Support tickets and MDI claims queries as needed

Assist Plan Building Specialist III with programming new group implementations as needed

Assist with complex and escalated customer service issues to ensure resolution

Retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups

Assist in training of Plan Building Specialist I team members

Review and respond to applicable TechOps Support tickets and MDI claims queries as needed

Conduct peer-to-peer audit for Plan Building team programming

Qualification

QicLink knowledgeAnalytical skillsBenefit design regulationsVerbal communicationWritten communicationInterpersonal skillsTeam collaboration

Required

High school diploma or equivalent experience required

3-5 years of recent relevant experience

Clear and effective verbal and written communication skills

Strong interpersonal skills and ability to work with team members at all levels

Preferred

Strong QicLink knowledge is beneficial for the programming of benefits in QicLink

Strong analytical skills are crucial for translating client intent into programming of their benefits in QicLink

Comprehensive understanding of benefits that we administer and different plan types

Solid understanding of regulations that impact benefit design, including but not limited to, the Affordable Care Act, Mental Health Parity and IRS rules related to administration of high deductible health plans