View All Jobs, Sorted by Date

Health Plan Software Analyst

National Employee Benefits Administrators, Inc.

in Remote / Hollywood FL / West Palm Beach FL / Atlanta GA / Hybrid

POSITION PURPOSE

The Health Plan Software Analyst is responsible for reviewing, documenting, and configuring health plan administration software based on Summary Plan Descriptions, regulatory updates, and vendor requirements. Additionally, the role will be responsible for providing internal support and technical assistance to the Claims and Enrollment Departments.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

To be successful in this role, an individual must be able to perform in a satisfactory manner the functions listed below. We will make reasonable accommodations to enable individuals with disabilities to perform these functions.

ESSENTIAL FUNCTIONS

• Interpret and document plan rules as outlined in the Plan Document and other sources, including but not limited to:
• Eligibility Rules
• Member Contribution Requirements
• COBRA Regulations
• Benefit Designs
• Disability Rules
• Regulatory Changes
• Configuration of plan requirements and code sets in graphical, text and web-based programs, including but not limited to:
  • Claims and Eligibility schedules
  • Claims Auto Adjudication
  • Rate tables
  • Updates due to Regulatory Changes
  • Client Structure
  • Data Exports
• Develop and execute test plans to implement Quality Assurance measures.
• Create training plans, materials, and schedules to support system changes.
• Conduct training for department managers and end users.
• Analyze, interpret, document, and implement vendor proprietary data layouts.
• Attend frequent status meetings with outside vendors.
• Use problem-solving and investigative skills to troubleshoot system issues. Document and implement solutions.
• Collaborate with departmental resources to improve or streamline processes.

OTHER FUNCTIONS

• Performs other duties as assigned.

EDUCATION AND/OR EXPERIENCE

To perform this job successfully, an individual must have the following education and/or experience.

• 2+ years of related experience in:
  • configuration of benefit plan administration software, including health claims adjudication software
  • analysis and interpretation of benefit plan governing documents
  • analysis and interpretation of reporting and file layout requirements relating to health plan data exchanges
  • creating process documentation or training materials
• Proficiency in Microsoft Office Suite and advanced skills in Microsoft Excel.
• Knowledge of medical terminology and health plan terminology.
• Experience working in the healthcare benefit administration industry.
• Working knowledge of the Bridgeway Benefit Technologies LLC (formerly BASYS) software or similar benefit administration software is a plus.

KNOWLEDGE, SKILLS, AND ABILITIES

The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform each essential duty satisfactorily. We will make reasonable accommodations to enable individuals with disabilities to perform these functions.

• Excellent problem-solving and analytical skills.
• Strong communication skills, both verbal and written.
• Ability to multitask, prioritize, and manage time efficiently.
• Self-motivated and able to work with minimal supervision.
• Ability to independently communicate system functions and requirements to developers and vendors.

PHYSICAL DEMANDS

The physical demands described here are representative of those an individual must meet in order to successfully perform the essential functions of this job. We will make reasonable accommodations to enable individuals with disabilities to perform these functions.

• Ability to sit for extended periods of time and to move intermittently throughout the workday.
• Ability to move in and between various facilities and handle exposure to inclement weather.
• Strong sensory skills, such as good eyesight, good hearing, and dexterity.
• Good speaking and listening skills.
• Ability to perform focused work with close attention to detail.
• Ability to operate office equipment, including computers, copiers, fax machines, and phones.
• Ability to interact with others, both in person and through phone, e-mail, and written correspondence.
• Ability to lift up to 25 pounds.
• Travel Requirement – Up to 15%.

LOCATION

This is a full-time position based in office or remote. The typical work schedule is Monday through Friday.

How to Apply

Please apply using the "Apply Now" button below.

Apply Now

View All Jobs, Sorted by Date

Manage This Listing (employer only)