Benefit Plan Configuration Specialist - Plan Build

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

Summary of role:

As a Benefits Plan Configuration Specialist, you will focus on understanding, translating, and configuring medical and dental plan designs into the core claims platform to ensure accurate processing of claims. You will maximize effectiveness of the core claims platform by continuously evaluating current processes and business needs along with system capabilities. You will create logic sets, based on code mapping, with an emphasis on accuracy and proficiency.

Responsibilities Include:

Create the blueprint for configuration of the plan from plan documents and/or plan standards.

Build, validate and test medical and dental plan benefits and associated code mapping logic.

Make necessary plan building and logic revisions when plans are amended.

Build auto-adjudication logic and test for integration with plan.

Resolve system issues and act as contact for opening and closing jobs on the core claims platform job list.

Test open jobs on new releases from the core claims platform and troubleshoot problems prior to loading into production.

Troubleshoot system problems, develop resolutions and/or “work around” procedures.

Work with Department Managers, Team Leaders, and other applicable personnel to improve efficiency within the company.

Coordinates the development of solutions for system related issues that may prevent the use of automated or standard processing methods.

Communicate changes to other departments and help with any required training necessary because of system changes.

Maintain the claim system Plan Building mailbox to research and resolve system issues.

Qualifications:

Required Skills and Abilities:

Knowledge of professional and institutional claims adjudication.

Ability to interpret plan documents and amendments and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes.

Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.

Ability to adapt to a constantly changing environment.

Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions.

Demonstrated ability to work in a fast-paced, agile environment managing multiple issues with pressure of production schedules and deadlines.

Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.

Proficiency in Microsoft Office applications and other web-based software applications.

Ability to learn new proprietary computer systems.

Education and Experience:

Prior experience with a highly automated and integrated claim adjudication systems.

Prior experience in a start-up environment is a plus.

Preferred Qualifications:

4 to 5 years of health insurance related Plan Building experience with TPA and Self-Funding processes.

Associates or Bachelor’s degree preferred.

Work Location:

An ideal candidate would be assigned to the Buffalo Office with ability to work from home.

This position is remote or hybrid.

Centivo Values:

Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.

Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon .

Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive .

Who we are:

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com .

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.