Plan Build Specialist

Primary Responsibilities:

• Develop, configure, and maintain healthcare plan designs and benefit configurations in various systems.
• Ensure all plan configurations support auto adjudication and meet regulatory and compliance requirements.
• Regularly review and update plan configurations to reflect changes in healthcare policies and regulations.

System Integration and Maintenance:

• Oversee the integration and interoperability of different healthcare systems to streamline auto adjudication processes.
• Facilitate system upgrades, patches, and maintenance to ensure seamless operation and minimal downtime.
• Collaborate with IT and other departments to implement new technologies and enhancements.

Testing and Quality Assurance:

• Perform comprehensive testing of plan configurations to ensure accurate and efficient claims adjudication.
• Identify and resolve any discrepancies or issues in the adjudication process.
• Create and document testing protocols and procedures to maintain high standards of quality and accuracy.