Plan Benefit Analyst

S&S Healthcare•Cincinnati, OH

5d•$23 - $29

About The Position

The Plan Benefit Analyst is responsible for analyzing, interpreting, and supporting the administration of health and welfare benefit plans. This role reviews plan documents, benefit specifications, and related materials to understand how benefits are intended to operate and helps ensure those provisions are accurately reflected in claims administration systems and business processes. The Plan Benefit Analyst works closely with internal teams to research benefit questions, interpret plan provisions, validate benefit configurations, investigate claims-related issues, and support the implementation and maintenance of client benefit plans. The role requires strong analytical and problem-solving skills, attention to detail, and the ability to translate complex benefit information into clear and practical solutions. This position does not involve software programming or coding. It requires the ability to understand benefit plan design, identify how plan provisions should be administered, and work effectively with systems and business partners to support accurate benefit administration.

Requirements

Previous experience in employee benefits, health plan administration, claims administration, benefits consulting, or a related field.
Ability to read, understand, and interpret benefit plan documents, SPDs, benefit summaries, and related materials.
Strong analytical, mathematical, critical-thinking, and problem-solving skills, with the ability to research complex questions and determine appropriate solutions.
Understanding of common health plan concepts, including deductibles, coinsurance, copayments, out-of-pocket maximums, eligibility, exclusions, limitations, accumulators, and network benefits.
Familiarity with health insurance claims and the relationship between plan provisions and claims administration preferred.
Experience working with claims administration, benefits administration, or other healthcare/benefits systems preferred.
Highly organized and detail-oriented, with a strong focus on accuracy, consistency, and quality.
Excellent verbal and written communication skills, with the ability to explain complex benefit concepts clearly and professionally to internal teams and, when appropriate, clients.
Ability to prioritize and manage multiple requests, projects, and deadlines simultaneously.
Proficiency with Microsoft Office, particularly Excel and Word; experience working with data, spreadsheets, or reporting tools preferred.
Ability to learn new systems, processes, products, and benefit designs and adapt effectively to changing priorities.
Demonstrated ability to protect confidential and sensitive information, including employee and member information.
Ability to work effectively and professionally with coworkers, clients, and business partners while maintaining a respectful and team-oriented approach.

Responsibilities

Review and analyze medical, dental, vision, and other benefit plan designs, specifications, and requirements to understand how benefits should be administered.
Review Summary Plan Descriptions (SPDs), plan documents, benefit summaries, amendments, and other supporting documentation and interpret applicable plan provisions.
Research complex benefit questions involving eligibility, coverage, limitations, exclusions, deductibles, coinsurance, out-of-pocket requirements, accumulators, and other plan provisions.
Research claims and benefit-related issues to determine whether claims have been administered consistently with applicable plan provisions and identify potential discrepancies.
Work with Plan Build and other system teams to validate that benefit plan configurations accurately reflect plan documents and specifications.
Translate benefit plan requirements into clear specifications and provide guidance regarding how plan provisions should be represented within claims administration systems. This role does not involve software coding.
Participate in testing of new and modified benefit plans, review test results, identify discrepancies, and work with appropriate teams to resolve issues before implementation.
Investigate complex benefit and administration issues, identify root causes, and recommend appropriate resolutions based on plan provisions, business requirements, and established processes.
Collaborate with Claims, Plan Build, Client Services, Eligibility, Product Development, Compliance, and other internal teams on benefit-related questions and initiatives.
Support Product Development and other internal teams by analyzing benefit requirements and identifying the operational and administrative considerations associated with new or enhanced products.
Assist with client-related benefit questions and requests as directed, providing clear and accurate information based on applicable plan documentation and established processes.
Maintain working knowledge of applicable employee benefits requirements, including HIPAA, the Affordable Care Act, and other regulations relevant to benefit administration.
Maintain accurate documentation of benefit interpretations, research findings, testing results, and other information necessary to support consistent administration.
Identify opportunities to improve benefit analysis, documentation, testing, and administration processes to increase accuracy, efficiency, and consistency.
Manage multiple benefit-related requests and priorities, track assignments and deadlines, and communicate status, issues, and expected completion timelines to appropriate stakeholders.
Perform other duties and responsibilities as assigned.