Personify Health · 21 hours ago
Lead Plan Build Specialist
United States
Full-time
Remote
Senior Level
$26/hr - $35/hr
5+ years expPersonify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. The Lead Plan Building Specialist is responsible for translating complex benefit plan designs into functional claim processing configurations, ensuring accurate claims processing and payment integrity.
ConsultingConsumerElectronic Health Record (EHR)Health CareLifestyleMedicalSoftware
Responsibilities
Build complex benefit configurations: Analyze plan designs, benefit policies, and pricing arrangements, providing rigorous interpretation and translation into benefit configurations within claim processing system
Configure contract methodologies: Translate provider contract terms and payment arrangements into claim payment system logic ensuring accurate reimbursement processing
Review system updates: Evaluate documentation regarding updates and changes to member enrollment, provider contracts, benefit plan designs, claim processing guidelines, and system configuration requirements
Serve as technical expert: Act as subject matter expert for Personify claim systems, providing guidance and support to internal departments on complex claim processing issues
Train and develop team: Lead training programs for Plan Builders, sharing expertise in system configuration, plan interpretation, and troubleshooting methodologies
Optimize claims processes: Evaluate efficiency and reliability of claims processes through regular review and optimization of configuration logic for continuous improvement
Ensure payment accuracy: Test and audit claim payment accuracy against benefit plan designs and contract information to maintain processing integrity and compliance
Support cross-functional needs: Function as technical resource to other internal departments for resolving complex claim processing issues and system questions
Qualification
Required
Bachelor's degree or equivalent combination of education and experience
5 years experience working for TPA building benefit plans and pricing arrangements
Prior team leader or supervisor experience
Strong understanding of Javelina claim processing system
Ability to interpret and translate Summary Plan Descriptions (SPDs) into system logic and rule sets
Knowledge of provider and contract configuration
Expertise in identifying and troubleshooting claim discrepancies using SPDs, provider contracts, regulatory requirements, and claims-related resources
Proficiency in testing and auditing claim payment accuracy against benefit plan designs
Benefits
Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life, not the other way around
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
PTO policy because rest and recharge time is non-negotiable
Benefits effective day one—because you shouldn’t have to wait to be taken care of
Company
Personify Health
Personify Health is a software that provides health plan administration, comprehensive health navigation, and holistic well-being solutions.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$92MKey Investors
Insight Partners
2018-05-21Acquired
2018-01-01Private Equity
2015-05-27Series B· $92M
Leadership Team
Kristen Larson
SVP Client Growth
Andrew Jacobus
Vice President - Global Insights and Data Science Leader
Recent News
2026-01-23
Company data provided by crunchbase