Health Insurance Plan Builder

Health Insurance Plan Builder

Role Summary

The purpose of the Plan Builder is to ensure accurate and timely implementation and ongoing building of benefit plans into the Claims system; serves as a credible and reliable source of reference to the organization regarding benefit plan building and design, to ensure timely and accurate benefit applications and processing.

Daily role responsibilities:

Programs health benefit plans into the claims system to accurately adjudicate benefits.
Inputs plan design modifications and enhancements and verifies accuracy of output.
Handles technical inquiries related to provider contracts, billing, and plan benefits.
Communicates status of new accounts, renewals, and amendments.
Ensures the financial accuracy of claims payment.
Reviews "Summary Plan Documents" with appropriate team members.
Responsible for accurately maintaining and updating plan benefit changes and serves as a main point of contact for all benefit customizations and issue resolution as it relates to plan benefits.
Working knowledge of current HIPAA and Affordable Care Act laws.
Acts as a consultant to product development on how to implement and execute innovative products.
Practice root cause analysis to better overall processes, implications and problem resolution.
All other duties as assigned.

This position could be a good fit if you have:

Certified Medical Coder preferred
2 years solid claims background, computer proficiency processing.
Highly desirable: experience with plan benefit set-up and maintenance.
Experienced Claims Processor - Required.
Certified Medical Coder
Strong ability to understand Plan Documents and plan benefits.
Strong ability to know how each plan benefit should pay.
Strong math and analytical skills.
Excellent verbal and written communication skills.
Ability to organize and manage multiple tasks.
Strong logical thinking capability.
Computer proficiency.
Must be organized and detail oriented.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Physical and Emotional Demands:

While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, and talk or hear. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.

Equal Employment Opportunity Policy Statement

Lucent Health Solutions, Inc. is an Equal Opportunity Employer.