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Benefit Operations Specialist

1 hour, 55 minutes ago
United States
Full-time
Senior
Operations Specialist
Quality Assurance and Testing
Agile SQL
Apply Now
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017
View All Jobs 23

Description

  • Own all aspects of benefit configuration, including new plan setup, plan changes, claims testing, and regular audits.
  • Collaborate cross-functionally with product, development, and other stakeholders to ensure client requests are configurable.
  • Communicate benefit configuration setup, testing processes, and test claim results clearly to clients.
  • Recommend process and system improvements that increase efficiency and quality in plan and benefit design.
  • Work with internal teams to create new benefit options aligned with market needs, including government program expansion.
  • Develop standard and custom batch testing scenarios, inputs, and claim output reviews to validate benefit accuracy.
  • Create policy and procedure documentation, training materials, and education for cross-functional teams.
  • Maintain quality standards and production SLA response times.
  • Participate in client meetings to review benefit information and change requests, ensuring logic aligns with intended benefit design.
  • Partner with leadership and Client Services to develop plan designs, support go-lives, and troubleshoot benefit-related issues.

Requirements

  • Bachelor’s degree preferred.
  • 5+ years of TPA or health plan experience in medical benefit configuration, benefit testing, claims monitoring, SPD creation, medical coding, or related work.
  • 3+ years of experience with Cigna is a plus.
  • Experience with pharmacy, dental, or vision benefits is a plus.
  • Experience with self-funded plans, Medicare/government programs, and ERISA is preferred.
  • Strong attention to detail and the ability to manage shifting priorities in a fast-paced, deadline-driven environment.
  • Exceptional written and verbal communication skills.
  • Experience working with product and development teams and familiarity with Agile is preferred.
  • Preferred experience working with structured or unstructured data in Excel, SQL, and data visualization tools.
  • IFEBP certification is a plus.

Benefits

  • Salary range of $75,000 to $90,000 USD.
  • Opportunity to work on a first-of-its-kind integrated benefits team.
  • Chance to influence operational best practices in a growing healthcare technology environment.
  • Equal employment opportunity and a diverse, inclusive workplace.
  • Personal data retention only for application consideration, with privacy practices disclosed publicly.

Interested in this position?

Apply directly on the company website

Apply Now

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