Configuration Analyst II

Healthcare Management Administrators•Bellevue, WA

2h•$108,000 - $120,000•Remote

About The Position

The Configuration Analyst II is responsible for implementing and programming clients’ benefit plans, setting up buy-up products, and managing third-party vendor files to ensure benefits are correctly programmed and product services are available to members. The role performs system configuration and validation for new and renewing clients, gathers and clarifies requirements with business partners, and reviews existing benefit plans to recommend system capabilities, regulatory requirements, and benefit designs for new group implementations. The analyst configures benefits in the claims system, prepares user documentation, manages revisions and off-cycle benefit changes, documents workflows and decisions, and troubleshoots configuration issues. The role also supports training, reviews support tickets and claims queries, manages a tool for non-preferred PBMs, conducts peer audits, assists with BlueCard setup and related processes, supports EOB setup auditing, and participates in compliance reviews and other projects.

Requirements

High school diploma or equivalent experience.
3–5+ years of recent relevant Health Plan Configuration experience.
Comprehensive understanding of administered benefits and different plan types.
Understanding of self-funded plan structures, accumulators, stop-loss, and employer-specific plan variations.
Ability to analyze benefit documents, including SPDs and plan summaries, and translate them into system rules.
Strong understanding of regulations affecting benefit design, including the Affordable Care Act, Mental Health Parity, and IRS rules related to high-deductible health plan administration.
Experience troubleshooting configuration issues and validating system outputs.
Clear and effective verbal and written communication skills.
Strong interpersonal skills and ability to work with team members at all levels.
Ability to analyze and understand medical claims adjudication logic.

Nice To Haves

Growing familiarity with claims platforms or HRP systems used by TPAs.
Ability to create and run SQL queries.

Responsibilities

Perform system configuration and validation for new and renewing clients.
Collaborate with business partners to gather and clarify requirements.
Review prior benefit plans and recommend system capabilities, regulatory requirements, and benefit designs for new group implementations; present recommendations to new clients.
Configure benefits in the claims system and prepare corresponding end-user documentation for new group implementations.
Create claims-system benefit configuration revisions and prepare documentation for renewing clients and off-cycle benefit changes.
Document workflows, configuration decisions, and process updates.
Troubleshoot configuration issues and recommend solutions.
Review change requests for completeness and alignment with existing processes.
Provide Plan Configuration Analyst training and education and assist in developing training materials.
Communicate status updates and risks to senior analysts and the Plan Configuration Manager.
Review and respond to applicable TechOps Support tickets and BPO claims queries as needed.
Manage the SSO tool for non-preferred PBMs.
Conduct peer-to-peer audits of claims-system configuration.
Work with a Level III analyst to set up BlueCard requirements, including CHP negotiations, CBF payments, PAR requests, and plan-prefix setup.
Work with the Finance team on EOB setup auditing as needed.
Participate in code-categorization decisions and lead reviews of annual compliance requirements related to preventative services.
Participate in department and company-wide projects as needed.

Benefits

Paid time off: 17 days for individual contributors.
11 paid holidays.
Two paid personal days and one paid volunteer day.
Company-subsidized medical, dental, vision, and prescription insurance.
Company-paid disability, life, and AD&D insurance.
Voluntary insurance options.
HSA and FSA pre-tax programs.
401(k) retirement plan with company match.
Annual $500 wellness incentive and $600 wellness reimbursement.
Remote-work and continuing-education reimbursements.
Discount program.
Parental leave.
Up to $1,000 annual charitable-giving match.
Performance-based incentive bonus(es).
Flexible work schedules supporting employees in different US time zones.
Option to work remotely or at the renovated office, which has free parking, a gym, and refreshments.