Plan Build Auditor

HealthEZ•Edina, MN

2d•$75,000 - $95,000•Remote

About The Position

The Plan Build Auditor reviews, validates, and oversees the quality of benefit plan configurations to ensure accuracy, consistency, and alignment with approved business requirements and plan documentation. The role provides subject-matter expertise in plan configuration and claims adjudication, independently assessing configuration quality before implementation. Working with Plan Builders, Operations, and Leadership, the auditor evaluates configuration outcomes, identifies discrepancies, validates corrective actions, and supports improvements to quality standards and configuration practices. The role may also support complex plan builds, implementation initiatives, and departmental projects. This position can be supported 100% remotely. The target base compensation range is $75,000–$95,000 per year. HealthEZ offers a competitive total rewards package that includes health benefits, a 401(k) retirement plan, paid time off, and paid leave including parental leave.

Requirements

At least five years of experience in health plan configuration, claims administration, benefit plan operations, or a related healthcare environment.
At least one year of VBA Software knowledge.
Demonstrated knowledge of benefit plan design, claims adjudication, and configuration methodology.
Experience interpreting plan documents and translating requirements into system configuration.
Strong understanding of accumulators, limitations, exclusions, cost-share structures, and claim processing logic.
Experience performing testing, validation, or quality review activities within a plan configuration environment.
Strong analytical, problem-solving, and organizational skills.
Excellent attention to detail and commitment to accuracy.
Effective written and verbal communication skills.
Proficiency with Microsoft Excel and other business reporting tools.

Nice To Haves

Two years of VBA Software knowledge.
Experience auditing benefit plan configurations or implementation deliverables.
Experience within a health plan, third-party administrator (TPA), or healthcare payer environment.
Knowledge of exception codes, claim messaging, and adjudication-related configuration.
Experience supporting implementation projects and system enhancement initiatives.
Associate's or Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field.

Responsibilities

Conduct detailed reviews of new and modified plan configurations for alignment with approved requirements, plan documents, and configuration standards.
Validate system configuration outcomes through structured testing and claim adjudication review.
Review benefit structures, coverage limitations, accumulators, cost-share arrangements, provider network configurations, pricing methodologies, and related setup components.
Evaluate denial logic, exception code configuration, member responsibility indicators, remit messaging, and claim processing outcomes.
Document audit findings, communicate recommendations, and track resolution activities through completion.
Perform follow-up reviews to confirm corrective actions have resolved identified issues.
Analyze audit finding trends and recommend improvements to configuration quality and consistency.
Maintain audit documentation and support reporting on quality, accuracy, and implementation readiness.
Configure and maintain benefit plans according to approved requirements and business specifications.
Interpret plan documents and translate business requirements into system configuration.
Support implementation activities for new and existing clients, benefit changes, and system enhancements.
Participate in testing for configuration changes, system upgrades, regulatory updates, and operational initiatives and projects.
Serve as a resource for complex configuration scenarios and adjudication-related questions.
Collaborate with cross-functional teams to support successful implementation and ongoing operational performance.
Promote adherence to configuration standards, procedures, and departmental best practices.
Identify opportunities to strengthen quality controls and reduce configuration-related defects.
Conduct ongoing trend analysis of audit findings and quality results.
Provide timely, actionable feedback and recommendations to address recurring issues, strengthen controls, and improve configuration accuracy.
Update audit procedures, testing standards, configuration guidelines, and related documentation to reflect approved process changes and lessons learned.
Partner with leadership and team members to improve operational efficiency, consistency, and quality outcomes.
Participate in departmental initiatives and special projects as assigned.