Plan Benefit Analyst - REMOTE

S&S Health is a premier healthcare administration company located in Cincinnati, Ohio. We offer self, level, and fully funded solutions that lower costs while improving outcomes with a consumer-centric experience. Our integrated benefits, services, and technology platform have been developed to serve the needs of Employers, TPAs, and Health Systems. The company has a nationwide presence with the ability to sell and service in every state.

The Plan Benefit Analyst is responsible for building and maintaining medical, dental, vision, and other employee benefit plans within the claims processing system. This role requires a high level of attention to detail, accuracy, and the ability to work independently as well as collaboratively. The Analyst ensures that the logic within the claims system drives accurate and appropriate claims adjudication.

Key Responsibilities:

• System configuration of medical, dental, vision, and other benefit plans into the claims system to accurately adjudicate benefits, including initial build and subsequent modifications. Configuration is limited to utilizing logic-based modules embedded in the claims system; does not include actual coding.
• Verification of configuration output and collaboration with internal divisions to complete review and testing.
• Research and respond to technical inquiries related to system configuration, such as provider contracts, claims, and plan benefits.
• Track and communicate the status of configuration activities.
• Ensure financial accuracy of claims payment.
• Review Summary Plan Descriptions and other documents supporting system configuration with appropriate team members.
• Maintain a working knowledge of benefit-related regulations, including but not limited to HIPAA and the Affordable Care Act.
• Act as an advisor to product development regarding system configuration necessary to implement and execute innovative products.
• Apply root cause analysis to improve overall processes, implications, and problem resolution.
• Perform all other duties as assigned.

Qualifications:

• Experience in healthcare, particularly in employee benefits (e.g., medical, dental, vision) or claims administration, or an equivalent combination of education and experience.
• Strong critical thinking and problem-solving abilities.
• Excellent math and analytical skills.
• Proficiency in Microsoft Word, Excel, and other Office programs.
• Experience with claims administration systems.
• Ability to understand, apply, and convert benefit plan documentation into system configuration.
• Highly organized and detail-oriented.
• Effective verbal and written communication skills.
• Ability to manage multiple projects and prioritize tasks.
• Team-oriented and adaptable to change.
• Professional and respectful in all interactions.
• Ability to handle confidential information appropriately.

We are committed to creating a safe and secure workplace for all employees. Please note that all final candidates will be subject to a comprehensive background check and drug testing as part of our hiring process.