Leads configuration design and execution for complex requirements.
Acts as SME for requirements gathering sessions with business and technical stakeholders.
Develops detailed configuration design documents, process flows, and related artifacts.
Analyzes current and future state processes to optimize system functionality.
Reviews and validates complex change requests for system impact and compatibility.
Provides advanced troubleshooting and recommends system or process improvements. Provides input and coordination of cross-functional activity to support custom benefit review process.
Reviews prior benefit plans and makes recommendations for new group implementations, such as system capabilities, regulatory requirements, and benefit design recommendations and presents to new clients during implementation.
Configure benefits into our claims system and prepare corresponding end-user documentation for new group implementations.
Creates claims system benefit configuration revisions and prepare corresponding end-user documentation for renewing clients and implementation of off-cycle benefit changes, as needed.
Reviews and responds to applicable TechOps Support tickets and BPO claims queries, as needed.
Provides training and mentors junior Plan Configuration Analysts to support their development.
Conducts peer-to-peer audit for claim system configuration.
Act as SME for BlueCard setup requirements. This includes, but is not limited to, negotiations with CHP (Consortium Health Plans) and processing of CBF (Capitated Billing Format) payments, PAR requests, and plan prefix setup.
Communicates progress, risks, and issues to the Plan Configuration Manager.
Acts as Plan Configuration SME as a member of CPET, providing guidance and insights related to plan configuration capabilities and recommendations to allow the CPET team to make informed decisions. Provides CPET decision updates, prepares documentation, and related training to Plan Configuration team.
Participates in code categorization review and decisions related to new and existing diagnosis and procedure codes.
Participates in various department and company-wide projects as needed.

Requirements

High school diploma or equivalent experience required, bachelor’s degree preferred.
5-7+ years of recent relevant Health Plan Configuration experience
Deep understanding of benefit plan design, accumulators, coordination of benefits, provider reimbursement, and claims adjudication logic.
Proven ability to interpret complex plan documents, regulatory requirements, and client‑specific plan variations.
Experience leading requirements sessions with internal teams or employer groups.
Strong troubleshooting skills and the ability to anticipate downstream impacts across enrollment, claims, billing, and reporting.
Experience mentoring junior analysts and supporting cross‑functional teams.
Strong verbal and written communication skills.
Strong interpersonal skills and ability to work with team members at all levels.
Extensive ITS and Blue2 knowledge is required.
Ability to create and run SQL queries required.
Strong understanding of regulations that impact benefit design, including but not limited to, the Affordable Care Act, Mental Health Parity and IRS rules related to administration of high deductible health plans.

Benefits

Seventeen (IC) days paid time off (individual contributors)
Eleven paid holidays
Two paid personal and one paid volunteer day
Company-subsidized medical, dental, vision, and prescription insurance
Company-paid disability, life, and AD&D insurances
Voluntary insurances
HSA and FSA pre-tax programs
401(k)-retirement plan with company match
Annual $500 wellness incentive and a $600 wellness reimbursement
Remote work and continuing education reimbursements
Discount program
Parental leave
Up to $1,000 annual charitable giving match
Flexibility to work schedules that support people in all time zones across the US

Applicant Tracking System Keywords

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

Hard Skills & Tools

Health Plan Configurationbenefit plan designaccumulatorscoordination of benefitsprovider reimbursementclaims adjudication logicSQL queriestroubleshootingprocess optimizationdocumentation preparation

Soft Skills

mentoringcommunicationinterpersonal skillsteam collaborationleadershipproblem-solvinganalytical thinkingrequirements gatheringtrainingstakeholder engagement