Benefit Plan Configuration Specialist

Centivo is a new type of health plan administrator that allows self-funded employers and clinicians to join forces and deliver high quality, affordable healthcare to their employees. An alternative to traditional insurance carriers or third-party administrators, Centivo offers the technology, network, claims processing, customer support, and population health management to fully administer health benefits for all or a portion of an employee population.

At Centivo, we never lose sight of the fact that we are dealing with healthcare, with emotions, with anxiety, with fear, and with lives. We treat your employees and their families with the same level of care that we would use to treat our own families.

Summary of this role:

The System Configuration Specialist position is responsible for the general configuration and maintenance of the Core Claims System. The successful candidate will be responsible for assisting in the ongoing configuration, management and oversight in the Core Claims system.
The System Configuration Specialist must have the ability to quickly identify, triage, diagnose, and resolve reported issues with the intent of improving the performance of the system for business units. Tasks and decision-making are generally independent in nature but will require collaboration with internal and external partners frequently.
The position will report to the Director of System Configuration.

Focus areas:

Each System Configuration Specialist will have a focus area specific for that role:
  • Client Configuration – with a focus on billing, funding, stop loss, enrollment and COBRA
  • Benefits/Plan Configuration – with a focus on adjudication logic, benefit plans, workflow and claims/clinical edit
  • Network/Provider Configuration – with a focus on provider network, provider contracts, PCP/Call Groups and fee schedules

Job interactions:

Coordinates with all business units and external vendors during client implementations and/or conversions to determine requirements.
This role assures that interfaces between internal systems and vendor interfaces meet client needs as well as operational processes.

In this position you will have the following responsibilities:

  • Analyzing new configuration and changes to existing configurations to perform all Client and Claims administration based on product design and functionality and perform test validation as needed
  • Making online and ad-hoc configuration changes within Javelina and supporting systems
  • Analyzing, interpreting, loading, testing and maintaining configuration tables and files
  • Ad-hoc reporting of provider rosters, claims adjustment reports, membership assignments, PCP relationships within the Javelina and supporting systems
  • Performing unit and/or end user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes as necessary that affect claims adjudication and member/client funding functionality
  • Proactively identifying opportunities and recommending system solutions that increase automation, resolve system deficiencies, and enhance claims processing and reporting to meet and exceed business requirements.
  • Perform unit and/or end user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes as necessary that affect claim adjudication rules.
  • Interact and coordinate system changes and schedules as necessary with the Technical Systems Analysts.
  • Act as a liaison with specified user areas to define business requirements and processes for project deployment.
  • Duties and responsibilities are not intended to be all-inclusive; they represent key elements considered necessary to successfully perform the role.

Education and experience

  • Understands health insurance benefit administration in a Self-Funded environment
  • Knowledge of professional and institutional claims adjudication.
  • Coding knowledge and experience with CPT, HCPCS, ICD9, CDT, Revenue, DRG and other relevant medical and industry-standard codes.
  • Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.
  • Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions.
  • Demonstrated ability to work in a fast-paced environment managing multiple issues with pressure of production schedules and deadlines.
  • Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.
  • Proficiency in Microsoft Office applications and other web-based software applications
  • Ability to learn new proprietary computer systems

Knowledge, skills & abilities:

  • Understands health insurance benefit administration in a Self-Funded environment
  • Knowledge of professional and institutional claims adjudication.
  • Coding knowledge and experience with CPT, HCPCS, ICD9, CDT, Revenue, DRG and other relevant medical and industry-standard codes.
  • Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner.
  • Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions.
  • Demonstrated ability to work in a fast-paced environment managing multiple issues with pressure of production schedules and deadlines.
  • Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.
  • Proficiency in Microsoft Office applications and other web-based software applications
  • Ability to learn new proprietary computer systems
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