Senior Benefit Plan Configuration Analyst

$52,250 - $78,390/Yr

Prime Therapeutics - Springfield, IL

Full-time - Mid Level

Springfield, IL

Administrative and Support Services

About the position

The Senior Benefit Plan Configuration Analyst specializes in analyzing and applying complex benefit design requirements. This role ensures high quality and accuracy in benefit configuration, test execution, and validation efforts, while serving as a subject matter expert on benefits and claim adjudication system coding setup.

Responsibilities

• Designs, analyzes and implements benefit coding change requests with a high degree of accuracy.
• Gathers and analyzes client requirements, assesses the benefit impact on current design and claims processing, presents to stakeholders with benefit setup options, and advises on the best solution.
• Manages less standardized plan design concepts, clients, and programs from a coding, testing, and validation perspective.
• Facilitates conversations within the team to define client intent or program setup.
• Facilitates and troubleshoots inquiries amongst multiple internal and external teams until resolution and implementation.
• Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specifications and data flow from which programs are developed and coded.
• Actively participates in and contributes to daily communications, team meetings and project/issue resolution.
• Participates in and leads internal calls with clients to understand the intent of requested benefit changes.
• Identifies, analyzes and presents to leadership creative solutions for process improvement activities regarding benefit configuration.
• Analyzes new business requirements for benefit design changes to establish the appropriate solution.
• Responsible for accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests.
• Maintains customer documentation that validates configuration.
• Efficiently and effectively distributes tasks, using clear and concise instructions and expectations.
• Completes deliverables independently and within an agile team setting.
• Coordinates responses to both external and internal audits, ensuring workflows support compliance and identifying when audit protocols need to be refreshed.

Requirements

• 2+ years of experience in benefit plan configuration/analysis.
• Experience with adjudication processes (FirstRx preferred), analyzing benefit plan design and system application.
• Advanced working knowledge of Microsoft office products (specifically Word, Access, Excel), including running queries and macros.
• Advanced knowledge of interpreting and understanding prescription benefits.
• Strong attention to detail, critical thinking and analytical skills.
• Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
• Strong sense of urgency leading to the timely completion of all projects, training and assignments.

Benefits

• Health insurance
• 401k
• Paid holidays
• Flexible scheduling
• Professional development
• Tuition reimbursement