Benefit Config Analyst I

Moda Health•Portland, OR

4d•Remote

About The Position

Responsible for benefit configuration and administration for all new and renewing Medical or Dental groups, with a focus on standard and plans of low to moderate complexity, including table update projects, achieving the highest possible auto-adjudication rates, while at the same time maintaining excellent quality. Maintain Enterprise Benefit Tracker (EBT) notes groups as needed to provide additional clarity to internal and external users regarding benefit specifics. Analyzes system solutions, defines and builds benefit designs, and maintains configuration within the systems. This is a FT WFH position.

Requirements

Bachelor’s degree or equivalent work experience.
1 - 3 years prior Healthcare/Insurance experience is required.
Knowledge of existing claims procedures, which may be demonstrated by 1-2 years as Lead Claims Processor, Claims Auditor, Customer Service Representative, or other related position in the insurance industry.
Consistently exceeding all levels of performance or equivalent experience.
Ability to gather business requirements for specialized groups or projects.
Ability to analyze and recognize potential business impacts for impacted departments regarding benefit and/or contract changes and to offer probable solutions or alternatives.
PC proficient with good working knowledge of Microsoft Word and Excel.
Ability to communicate effectively, both orally and in writing with users, systems personnel, vendors, clients and management.
Ability to correctly interpret contracts, coupled with state and federal laws and limitations, and to convert into Facets benefit configuration.
Ability to plan, organize and prioritize task assignments to ensure established guidelines, timelines and quality goals are met.
Ability to document business processes.
Ability to come into work on time and on a daily basis; work additional hours as needed.
Ability to work independently, with minimal supervision.
Maintain confidentiality and project a professional business image.
A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
Must be comfortable being on camera for virtual training and meetings.

Nice To Haves

preference for those with experience building benefits in Facets or other systems.
Strong system knowledge of Facets and Enterprise Benefit Tracker, or equivalent Health Insurance benefits systems.

Responsibilities

Creates and maintains Facets benefit components and configures standard products or those of moderate complexity for new and renewing Medical or Dental groups as well as updating and maintaining EBT.
Products that are of higher complexity may be assigned but will be expected to require assistance from others on the team.
Participates in meetings representing Benefit Configuration Administration to fully understand plan benefits and validate Facets capabilities.
Ensures benefit configuration turnaround times are met for all new and renewing groups.
Answers inquiries from Medical or Dental claims departments, Underwriting, Marketing, Professional Relations and Business Implementation Unit regarding contract and product set-up issues on medical or Dental group business.
Performs quality audits on benefit configuration at the direction of department management.
Performs quality assurance testing on test claims to validate benefit configuration will meet the needs of the Medical or Dental Claims departments.
Evaluates and resolves benefit configuration questions via WorkFlow claims inquiries.
Communicates product updates and changes to the Claims departments, Marketing and Contracts via e-mail, inter office mail or EBT updates.
Assists with department projects and reports at the direction of department management.
Interprets benefit information from the group application and or contract language in order to create a product within corporate turnaround time standards.
Problem solves, by thinking “outside the box” to identify the most efficient use of the system’s capability from a corporate perspective.
Identifies situation where benefit configuration alone cannot fully meet the plan’s requirements.
Works with departmental management, and cross functionally, to identify the Workflow configuration and associated business processes needed.
Documents departmental policies and business processes as assigned by department management.
Performs other duties as assigned.