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.
What YOU will do: - 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.
RequirementsKnowledge, Experience, and Key Attributes needed for Success: - 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.
BenefitsThe base salary for this position in the greater Seattle area is $90,000-$110,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available.
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
In addition, HMA provides a generous total rewards package for full-time employees that includes:
- Seventeen (IC) days paid time off (individual contributors)
- Eleven paid holidays
- Two paid personal and one paid volunteer day
- Company-subsidized medical, dental, vision, and prescription insurance
- Company-paid disability, life, and AD&D insurances
- Voluntary insurances
- HSA and FSA pre-tax programs
- 401(k)-retirement plan with company match
- Annual $500 wellness incentive and a $600 wellness reimbursement
- Remote work and continuing education reimbursements
- Discount program
- Parental leave
- Up to $1,000 annual charitable giving match
How we Support your Work, Life, and Wellness GoalsAt HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)
HMA requires a background screen prior to employment.
Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.
For more information about HMA, visit www.accesshma.com.
