Plan Builder - Health Insurance

You thrive in a fast-paced environment. You’re curious and have an eye for detail. You strive to exceed expectations and succeed. You’re excited by the opportunity to join a fast-growing company with unlimited opportunities for growth & competitive benefits. Does this sound like you? If so, Boon-Chapman could be the place for you!

Job Summary

This role manages claim payment functions within the HealthPac Alim Processing System, focusing on building and updating plans for various coverages, implementing and resting adjudication logic, and handling system issues. The position requires troubleshooting skills, communication with departments, for process improvement and training, and strong proficiency in Microsoft Office. Ideal candidates should have at least two years of health insurance experience, with a high school diploma or equivalent; a bachelor’s degree is preferred. This role reports directly to the Director of Plan Operations.

Job Responsibilities

• Build all new medical, dental, disability, and vision plans, including logic.

• Make necessary plan building and logic revisions when plans are amended.

• Build auto-adjudication logic and test for integration with plan.

• Maintain system issues and act as contact for opening and closing jobs on the Healthpac job list.

• Test open jobs on new releases from Healthpac and troubleshoot problems prior to loading into production.

• Troubleshoot system problems, develop resolutions and/or “work around” procedures.

• Responsible for accurately entering plan information received by the Service Department into the Net Recall Fax Back function in a timely manner.

• Work with Department Managers, Team Leaders, and other applicable Boon-Chapman personnel to improve efficiency within the company.

• Communicate changes to other departments and help with any required training necessary because of system changes.

• Assist benefits department with software related problems by coordinating with the IT Department and software vendor for resolution of such problems.

• Reporting functions related to plan-building, benefit or contract changes.

• Attend training sessions both internally and externally to enhance knowledge of the claim system.

• Perform other duties as assigned by the Director of Plan Operations.

What We’re Looking For (Nobody’s Perfect, But Experience is a Plus!)

• High school diploma or equivalent with some college or related experience. Experience and education may be substituted for one another.

• At least two years of health insurance-related experience, preferably as a Plan Builder or Claims Analyst.

• Knowledge of internal policies and procedures.

• In depth knowledge of the Healthpac claim system software programs.

• Ability to interpret plan documents and amendments and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes.

• Ability to share knowledge and train others on the claim system functions in the Healthpac Claim system.

• Ability to adapt to a constantly changing environment.

• Ability to multi-task.

• Ability to accurately compile data and perform detailed work.

• High school diploma or equivalent. Bachelor’s degree in business, communication or healthcare management preferred. Employee benefits experience required. TPA experience preferred.

• Must have exceptional interpersonal and written communication skills.

• Must have a passion for customer service.

• Must have exceptional documentation and organization skills.

• Must be able to work independently 

• Must possess a team player mentality with focus on collaboration skills.

• General knowledge of business correspondence, filing, and general office procedures.

• Skill in data analysis and recognition of pertinent data elements.

• Skill in clearly presenting complex procedures and database parameters.

• Skill using Microsoft Word, Excel and Access. Skill in critical thinking.

• Ability to meet deadlines

• Ability to maintain regular attendance

• Ability to maintain confidentiality of material and information

• Ability to maintain professional appearance and demeanor

• Ability to work as a member of a team and with other departments.

Physical Requirements

• Must be able to remain in a stationary position for 80% of the time.

• Must use close visual acuity to perform an activity such as: preparing and analyzing data and figures, transcribing, viewing a computer terminal and expansive reading.

• Must be able to lift or move items up to 20lbs.

• Must have the ability to move files, open filing cabinets and bend or stand as necessary.

The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.