Responsible for processes within the health plan's core administrative systems related to the building and quality assurance of new and renewing benefit plans. Responsible for the creation and posting of DHP member Certificates, Summaries of Benefits and Coverages and other miscellaneous member facing documents. These processes are critical to ensure the accurate application and documentation of plan benefits and the correct administration of member claims.
Job Responsibilities and Requirements:
Utilizing high level Excel skills, create and maintain interactive job aides that support the creation and quality assurance of benefit plan builds, benefit narratives and member facing documents.
Define, create, test and maintain detailed benefit plan designs. This includes the creation of templates to assign financial liabilities to benefit plans within the claims administration system.
Participate in departmental and cross-departmental activities related to the creation of benefit designs and benefit plan builds. Provide expert knowledge, analyses and technical recommendations to these teams.
Create and analyze reports for quality assurance activities to ensure that the plans in production in the claims system accurately reflect detailed plan designs. Complete all benefit remediation as required by quality assurance activities, regulatory changes, and benefit configuration modifications introduced throughout the year.
Create member facing documents including Summaries of Benefits and Coverages, Certificates of Coverage, and Schedules of Benefits utilizing Microsoft Office or other document management systems. Ensure that documents meet requirements from federal and state regulators. Publish documents to the Member Document Center for display on health plan websites for access by prospective and enrolled health plan members, agents, employers and health plan providers.
Configure, test and maintain benefit narratives for Electronic Data Interchange 270/271 transactions.
Provide production support for questions from across DHP related to member benefits and cost share accumulators.
Maintain and update technical and process documentation.
Support unit and patch testing for claim system upgrades
Perform training on processes related to assigned functional areas. Serve as subject matter expert for training within the department and across operations teams.
Performs other duties as assigned.
High school diploma.or equivalent
Four years' ofhealth insurance experience in health plan administration, claims operations or benefit administration
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Day Shift (United States of America)
97250188 700435-Benefits, Provider and Pricing Admi
Scheduled Weekly Hours:
SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.