Centivo is looking for a Configuration Specialist - Plan & Benefits Configuration to ensure our core claims platform processes medical and dental claims accurately. In this role, you will be the expert in translating plan designs into system configuration, maximizing platform effectiveness by evaluating processes and business needs.
What You'll Do
- Create the blueprint for plan configuration from plan documents and/or 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 the plan.
- Resolve system issues and act as the contact for managing jobs on the core claims platform job list.
- Test upgrades on new platform releases and troubleshoot problems prior to production deployment.
- Troubleshoot system problems, develop resolutions and/or 'work around' procedures.
- Work with Department Managers, Supervisors, Team Leaders, and other personnel to improve company efficiency.
- Coordinate the development of solutions for system-related issues that hinder automated or standard processing.
- Communicate changes to other departments and assist with any required training stemming from system changes.
What We're Looking For
- 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 configuration-related issues 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 under the 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.
- Skilled in HealthRules Payer/Designer or similar core administrative applications for plan configuration.
Nice to Have
- Prior experience in a start-up environment is a plus.
- 4 to 5 years of health insurance related Plan Building experience with TPA and Self-Funding processes.
- Associate or bachelor’s degree preferred.
Technical Stack
- Microsoft Office applications
- HealthRules Payer/Designer or similar core administrative applications
Team & Environment
You will work with Department Managers, Supervisors, Team Leaders, and other applicable personnel to improve efficiency and drive results.
Work Mode
This is a fully remote position.
Centivo is an equal opportunity employer.
