Health Plan Configuration Analyst - Mesa, AZ
16 hours ago
Job description
Essential Functions
Note: The essential duties and primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent's performance objectives as outlined by the incumbent's immediate supervisor or manager.
- Configure, implement, and maintain health plan benefits and related system applications in alignment with product design, contractual obligations, and regulatory requirements.
- Analyze existing health plans to identify required updates driven by market changes, legislative mandates, compliance requirements, and operational improvements.
- Translate business and product requirements into system configuration specifications.
- Support the end-to-end lifecycle of plan changes, including design review, system configuration, testing, validation, and implementation.
- Execute and document testing activities to ensure system accuracy, benefit integrity, and compliance with state and federal regulations.
- Partner with Product, Compliance, IT, Claims, and Operations teams to resolve system issues and implement corrective actions.
- Investigate configuration defects and support remediation efforts to minimize operational disruption and member/provider impact.
- Ensure adherence to audit controls, documentation standards, and internal governance processes.
- Contribute to the development and maintenance of standard operating procedures and configuration documentation.
- Support training initiatives and knowledge transfer within the team.
- Maintain awareness of evolving regulatory requirements and industry trends impacting health plan administration.
Marginal or Additional Functions
- Performs other duties as assigned or apparent.
Supervisory and Managerial Responsibility
- Supervisory/managerial responsibility is not applicable
Knowledge, Skills & Abilities
Education, Licensure or Certification:
- Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field
Work Experience or Related Experience:
- One to two (1-2) years of experience in health plan configuration, plan build, or related systems work
- Strong working knowledge of Microsoft Outlook, Word, PowerPoint, and Excel (including pivot tables, data comparison, and structured analysis)
- Experience in health insurance operations, preferably in claims processing, product development, benefits configuration, or customer service preferred
- Experience with benefits administration or claims processing systems preferred
- Working knowledge of Microsoft Access a plus
- Experience supporting audits or compliance reviews preferred
Specialized Knowledge, Skills & Abilities:
- Demonstrated attention to detail and ability to manage multiple assignments with accuracy
- Ability to interpret documented procedures, regulatory standards, and business requirements
- Strong analytical and problem-solving skills
- Familiarity with health plan regulatory requirements (e.g., state mandates, CMS guidelines, ACA requirements) preferred
Equipment:
- Working knowledge of a PC, business and communications software (MS Office) and web-based tools are required
Travel Requirements and Conditions
- No travel is required
Work Environment, Conditions and Demands
- Work is generally performed in an office environment or remote setting in which there is only minimal exposure to unpleasant and/or hazardous working conditions.
Physical Requirements and Demands
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
- This position entails a high level of work performed at a computer terminal throughout the day as well as heavy use of a telephone or headset equipment
- On a regular basis, incumbent frequently performs repetitive motions at a computer terminal and is subject to prolonged sitting
- Regular eye-hand coordination and manual dexterity is required to operate office equipment
Additional Position Information
- No additional information is applicable
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