Healthcare Management Administrators · 4 months ago
Plan Building Specialist II
United States
Full-time
Remote
Mid LevelHealthcare Management Administrators is a premier third-party health plan administrator dedicated to providing customized health plans for medium to large-size employers. The Plan Building Specialist II is responsible for implementing and programming client benefit plans, ensuring benefits are correctly programmed, and managing vendor files to facilitate non-standard benefits for select groups.
Health CareInsurance
Responsibilities
Review prior SPD’s and make recommendations for new group implementations, such as system capabilities and regulatory requirements, and present to new clients as needed. Ask clarifying questions about plan details that could be missing
Create and update plan summaries and program the claims system for simple and medium complexity client renewals and implementation of off-cycle benefit changes
With the assistance of the Plan Building Specialist II or III, assist with programming updates for clients with complex renewals
Assist with complex and escalated customer service issues to ensure resolution
Maintaining the vendor file maintenance for buy-up products. This includes incoming/outgoing files, setting up SFRP and retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups
Work with vendor to ensure accurate EOB design and setup as needed
Review and respond to applicable TechOps Support tickets and MDI claims queries as needed
Assist Plan Building Specialist III with programming new group implementations as needed
Assist with complex and escalated customer service issues to ensure resolution
Retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups
Assist in training of Plan Building Specialist I team members
Review and respond to applicable TechOps Support tickets and MDI claims queries as needed
Conduct peer-to-peer audit for Plan Building team programming
Qualification
Required
Experience in health plan administration or a related field
Strong analytical and problem-solving skills
Ability to manage multiple tasks and prioritize effectively
Excellent communication and interpersonal skills
Proficiency in programming and system capabilities related to benefit plans
Experience with vendor management and file maintenance
Ability to work collaboratively in a team environment
Detail-oriented with a focus on accuracy
Experience in customer service and handling escalated issues
Preferred
Experience with complex renewals and benefit changes
Familiarity with regulatory requirements in health plan administration
Experience in training or mentoring team members
Knowledge of EOB design and setup
Benefits
Comprehensive salary
Pay transparency
Benefits
Time off package
Personal development and growth opportunities
Company
Healthcare Management Administrators
HMA is Proving What's Possible in Healthcare®.
Founded in 1986
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Lindsay Harris
Board Member
Recent News
2025-09-30
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