Configuration Analyst II

Healthcare Management Administrators•Bellevue, WA

6h•$90,000 - $110,000•Remote

About The Position

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for four years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: This role is responsible for the successful implementation and programming clients benefit plans, as setting up buy up products for our clients as well as managing third party vendor files. The importance of this role is to ensure benefits are correctly programmed and product services are readily available for members.

Requirements

High school diploma or equivalent experience required
3-5+ years of recent relevant Health Plan Configuration experience
Comprehensive understanding of benefits that we administer and different plan types.
Understanding of self‑funded plan structures, accumulators, stop‑loss, and employer‑specific plan variations.
Strong ability to analyze benefit documents (SPDs, plan summaries) and translate them into system rules.
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.
Experience troubleshooting configuration issues and validating system outputs.
Growing familiarity with claims platforms or HRP systems used by TPAs.
Clear and effective verbal and written communication skills.
Strong interpersonal skills and ability to work with team members at all levels.
Ability to create and run SQL queries recommended.
Ability to analyze and understand medical claims adjudication logic.

Nice To Haves

Ability to create and run SQL queries recommended.

Responsibilities

Performs system configuration and validation for both new and renewing clients .
Collaborates with business partners to gather and clarify requirements.
Reviews prior benefit plans and makes recommendations for new group implementations, such as system capabilities and regulatory requirements, benefit design recommendations and presents to new clients.
Configures benefits into our claims system and prepares corresponding end-user documentation for new group implementations, as needed.
Creates claim system benefit configuration revisions and prepare corresponding end-user documentation for renewing clients and implementation of off-cycle benefit changes.
Documents workflows, configuration decisions, and process updates.
Troubleshoots configuration issues and recommends solutions.
Reviews change requests for completeness and alignment with existing processes.
Provides Plan Configuration Analyst training/education and assists in developing training materials.
Communicates status updates and risks to senior analysts and Plan Configuration Manager.
Reviews and responds to applicable TechOps Support tickets and BPO claims queries as needed.
Manages the SSO tool for non-preferred PBMs.
Conducts peer-to-peer audit for claims system configuration.
In conjunction with Level III analyst, set up BlueCard 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.
Work with the Finance team to conduct EOB setup auditing, as needed.
Participates in code categorization decisions and leads review of annual compliance requirements related to preventative services.
Participates in various department and company-wide projects as needed.