Dahl Consulting · 13 hours ago
Sr. Plan Builder and Configuration Analyst (28924)
United States
Full-time
Remote
Senior Level
$70K/yr - $80K/yr
5+ years expDahl Consulting is a healthcare benefits administration organization supporting employer-sponsored health plans. They are seeking an experienced Senior Plan Builder and Configuration Analyst to lead the design, build, and ongoing configuration of benefit plan adjudication rules, ensuring accurate claims processing and maintaining the integrity of complex claims systems.
ConsultingHuman ResourcesInformation Technology
Hiring Manager
Kristie Altstatt
Responsibilities
Lead the build, implementation, and maintenance of benefit plan adjudication rules
Configure benefits and system settings to support new and renewing employer groups, product launches, and client conversions, often under aggressive timelines
Ensure data integrity across the claims adjudication system and integrated vendors to support accurate processing of claims, adjustments, appeals, IDRs, and high-dollar claims
Collaborate with internal business partners and external vendors to support operational goals and system enhancements
Execute benefit configuration and client-level mapping aligned to industry standards, including CPT, place of service, and healthcare reform requirements
Evaluate client-requested exceptions and recommend alternative solutions that minimize system and operational impact
Serve as a subject matter expert for plan configuration by participating in Opportunity Action Reviews (OARs) and weekly SME meetings
Maintain and communicate documentation for exceptions, benefit standards, coding standards, and process variations
Analyze and design complex benefit and account structures based on customer requirements
Develop, document, and enforce internal policies and procedures; provide training and monitor compliance
Create and maintain standard protocols and best practices for plan naming, benefit parameters, network and benefit codes, exception and message codes, claim routing rules, auditing, procedure codes, and place of service configurations
Build and maintain robust testing scenarios that represent all coverage types and validate configuration changes prior to claim adjudication
Monitor performance metrics, perform variance analysis, and implement corrective actions as needed
Partner with claims processing and member experience teams to identify and resolve configuration-related issues
Analyze large claim data sets to identify billing patterns related to benefit design and configuration
Manage user roles and access within the claims processing system, including bi-annual access reviews
Participate in system enhancement assessments and communicate changes to impacted teams
Perform other related duties as assigned
Qualification
Required
5–10 years of experience in claims examination and/or benefit plan build and configuration
3+ years of business and operational experience within a health plan environment
Working knowledge of revenue codes and medical terminology
2+ years of experience conducting data analysis
Experience with commercial health plan design
High attention to detail with strong organizational and prioritization skills
Proven problem-solving ability and sound judgment in complex operational scenarios
Strong written and verbal communication skills
Ability to analyze performance data and produce actionable reporting
High school diploma or equivalent
Preferred
Professional medical coding experience
Experience with Virtual Benefit Administration (VBA) systems
Third-party administrator (TPA) experience
Medical coding certification (ICD?10, CPT, HCPCS)
Experience supporting large or complex benefit structures in a claims adjudication environment
Benefits
Health, dental, and disability coverage
401(k) retirement plan
Paid time off
Access to a health savings account (HSA)
Company
Dahl Consulting
Dahl Consulting is a staffing and recruiting company that offers talent management solutions.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Valerie Doherty
CEO
Company data provided by crunchbase