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Health Plan Configuration Analyst III

2 hours, 12 minutes ago
United States
Full-time
Senior
Business Analyst
Data Science and Analytics
SQL
Apply Now
Healthcare Management Administrators

Healthcare Management Administrators

Healthcare Management Administrators is a specialized third-party administrator that provides high-quality, innovative, and affordable health plans for self-funded employers, emphasizing exceptional service and a collaborative partnership model.

Insurance
251-1K
Founded 1986
View All Jobs 2

Description

  • Lead configuration design and execution for complex plan requirements.
  • Serve as a subject matter expert in requirements-gathering sessions with business and technical stakeholders.
  • Develop configuration design documents, process flows, and related implementation artifacts.
  • Analyze current-state and future-state processes to improve system functionality.
  • Review and validate complex change requests for system impact and compatibility.
  • Provide advanced troubleshooting and recommend system or process improvements.
  • Support custom benefit reviews and make recommendations for new group implementations and renewals.
  • Configure benefit plans in the claims system and prepare end-user documentation for new, renewing, and off-cycle changes.
  • Respond to TechOps support tickets and BPO claims queries as needed.
  • Train and mentor junior Plan Configuration Analysts and conduct peer-to-peer configuration audits.
  • Act as SME for BlueCard setup, including CHP negotiations, CBF payments, PAR requests, and plan prefix setup.
  • Communicate progress, risks, and issues to the Plan Configuration Manager and support CPET decisions and documentation.
  • Participate in code categorization reviews for diagnosis and procedure codes and contribute to department and company projects.

Requirements

  • High school diploma or equivalent experience required; bachelor’s degree preferred.
  • 5–7+ years of recent, relevant health plan configuration experience.
  • Deep understanding of benefit plan design, accumulators, coordination of benefits, provider reimbursement, and claims adjudication logic.
  • Proven ability to interpret complex plan documents, regulatory requirements, and client-specific plan variations.
  • Experience leading requirements sessions with internal teams or employer groups.
  • Strong troubleshooting skills and ability to anticipate downstream impacts across enrollment, claims, billing, and reporting.
  • Experience mentoring junior analysts and supporting cross-functional teams.
  • Strong verbal and written communication skills and strong interpersonal skills across all organizational levels.
  • Extensive ITS and Blue2 knowledge required.
  • Ability to create and run SQL queries required.
  • Strong understanding of regulations affecting benefit design, including the Affordable Care Act, Mental Health Parity, and IRS rules related to high deductible health plan administration.

Benefits

  • Base salary of $114,000–$142,000 in the greater Seattle area, depending on geography, skills, experience, education, and market factors.
  • Performance-based incentive bonus opportunities.
  • 17 days of paid time off for individual contributors.
  • 11 paid holidays, plus 2 paid personal days and 1 paid volunteer day.
  • Company-subsidized medical, dental, vision, and prescription insurance.
  • Company-paid disability, life, and AD&D insurance, plus voluntary insurance options.
  • 401(k) retirement plan with company match.
  • Annual $500 wellness incentive and $600 wellness reimbursement.
  • Remote work options and continuing education reimbursements.
  • Parental leave, discount program, and up to $1,000 annual charitable giving match.
  • Flexible schedules across U.S. time zones and access to a renovated office near Seattle with free parking, a gym, and refreshments.

Interested in this position?

Apply directly on the company website

Apply Now

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