Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The Benefit Configuration Analyst is a part of Health Plan Operations and helps to support all Benefit Configuration activities.
ROLE RESPONSIBILITIES
The Benefit Configuration Analyst description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Interpret and build code level benefits based on plan language
- Maintain builds throughout year due to regulatory and/or internal interpretation updates
- Work with TPAs to ensure proposed benefit designs will auto adjudicate and can be administered
- Provide strategic advice to ensure benefit language will result in high auto adjudication
- Assist audit of claims adjudication for compliance with benefit design
- Assist cross functionally when needed
SUPERVISORY RESPONSIBILITIES
- This position does not have supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Minimum high school diploma or GED is required; Associates or Bachelor’s degree preferred
- Five (5) or more years of experience in a like role is preferred; experience with plan build and benefit configuration preferred
- CPC
PROFESSIONAL COMPETENCIES
- Must have strong communication skills (verbal and written)
- Must be organized, detail-oriented, and be able to prioritize work to meet deadlines
- Must work independently with little supervision
- Experience in commercial and Medicare benefit design buildout required
BEHAVIORAL AND LEADERSHIP NORMS
- Bright Values: Lives the Bright Values. Is focused on bravery needed to develop a variety skills. Not afraid to ask questions or take risks. Focuses on purposeful planning and objective setting. Focuses on the team’s successes, and how to support that effort.
- Collaboration: Is an effective collaborator that works well with the functional team and others in the organization to align on timelines and effective delivery of a project or task. Is solution oriented and works on generating input from multiple constituents and driving the team to a solution. Is able to work with different personality types and teammates to overcome differences in opinion and thought to achieve common company goals.
- Delivers Results: Is results oriented. Focuses on results and the best and most efficient avenue for achieving results. Works with manager or appropriate liaison in the organization to work through goal setting and milestone development to ensure timely and high quality work product. Achieves strong results within functional area. Is focused on managing against a predetermined set of objectives, and creates and follows process.
- Exhibits Curiosity: Focuses on learning about the business at large. Seeks to understand how they can drive the business forward and how the bigger picture works. Actively participates in his/her own career development.
- Upward Management: While balancing multiple initiatives, successfully manages expectations with appropriate project owner about capacity, challenges and barriers to success. Is not afraid to ask for help, guidance or feedback.
LICENSURES AND CERTIFICATIONS
- Certified Professional Coder.
WORK ENVIRONMENT
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
