Plan Building Specialist

Plan Building Specialist

Who we are

Scalepex is a dynamic services firm specializing in providing nearshore solutions. We are committed to reshaping the way businesses harness talent globally. With a relentless dedication to excellence, we empower organizations to thrive in a rapidly evolving digital landscape. Our mission is to connect businesses with top-tier professionals from around the world, fostering collaboration, efficiency, and growth. At Scalepex, we blend cutting-edge technology with human expertise to deliver tailored solutions that drive success.

Our Client

We value and celebrate diversity and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than this, diversity is our strength, and a catalyst as #healthispersonal.

Job Description

The Plan Building Specialist is responsible for the build and maintenance of plan benefits for new and existing groups upon implementation, renewal, and changes

Your main responsibilities

• Support Implementation and Account Management teams by consolidating information during new client implementation and/or renewal to ensure the accuracy of benefits.

• Translate benefits from ICD10, HCPCS, CPT, CDT, and other insurance billing codes.

• Configure benefits in claims processing systems

• Generate benefits summaries, at a group level, for internal and external use in supporting member and provider understanding of available benefits

• Ensure compliance with applicable government regulations.

• Audit plans build work of other teammates.

• Process Group terminations, as needed

• Correspond with account managers, account coordinators, claims department, and other technical areas.

• Troubleshoot claims errors and refer escalated issues to team lead or manager.

• Supporting on-boarding and training of new team members.

Requirements

Required Qualifications

• 2+ years of experience in healthcare field, claims or benefits strongly preferred.

• Experience with Self-funded health plans strongly preferred.

• Strong working knowledge of medical billing and coding and/or medical claims processing

• High school diploma or general education degree (GED).

• Highly organized, detailed-oriented, and deadline-driven.

• Ability to read and interpret documents and instructions, short correspondence, and memos.

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

• Ability to deal with problems involving several concrete variables in standardized situations.

• Strong communications skills to effectively interact with various teams.