Responsible for all aspects of benefit configuration, including new plan setup, plan change setup, claims testing, and regular audits
Drives cross-functional collaboration with the product/dev team as well as additional stakeholder teams to ensure client customized requests are configurable for both new plan setups and plan changes
Clearly communicate benefit configuration setup and testing process or specific test claims to clients in a concise way that can be understood by users who are not experts in benefit areas
Make recommendations to streamline the work processes and systems that impact plan/benefit design to create efficiency and quality outcomes
Works cross-functionally to create new benefit options aligning with market needs, including expansion in government programs
Develop standards and custom batch testing scenarios and inputs, reviewing test claims output to validate claim accuracy against the clients’ benefit design
Develops standard policy and procedures, training materials and provide education for training and presentation to cross-functional teams
Maintain acceptable and appropriate quality levels and production SLA response time
Participate in client meetings to assess new client benefit information or change requests to ensure design of Judi logic ties to the benefit configuration intended to meet client needs
Partner with leadership to develop benefit plan designs and ensure that the plan designs meet client requests, Health Plan strategic/business parameters, and all regulatory and other oversight agencies’ requirements
Partner with Client Services team as clients go live and troubleshoot benefit-related discrepancies, errors, and problems
Support general business or team needs, as assigned

Requirements

Bachelor’s degree preferred
5+ years of TPA / health plan experience in Medical Benefit configuration, benefit testing, claims monitoring, SPD creation, Medical Coding or other applicable department needs
3+ years of experience with Cigna a plus
Pharmacy, Dental, or Vision experience a plus
Self-funded plans, Medicare/Government programs and ERISA experience preferred
Tremendous attention to detail, ability to shift priorities easily and ability to work in high paced, deadline drive environment.
Exceptional written and verbal communication skills
Experience working with product/dev teams and familiarity with Agile, preferred
Preferred: experience working with structured or unstructured data in Excel, SQL, and other data visualization tools.

Benefits

All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table.
We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

benefit configurationclaims testingbenefit designMedical CodingSPDs creationdata visualizationSQLAgilecustom batch testingclaims monitoring

Soft Skills

attention to detailability to shift prioritiescommunication skillscross-functional collaborationproblem-solvingtraining and presentationefficiency improvementclient assessmentconcise communicationteam support

Certifications

Bachelor's degree