BENEFIT PLAN TECHNICAL SPECIALIST

Aultcare Corp. - Canton, OH

Posted: 5/2/2024 - Expires: 7/31/2024

Job ID: 273102737

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Job Description

Req# 29005

Aultman Health Foundation, CANTON, OH

AULTCARE ADMINISTRATION

Aultman Health Foundation

Full Time, Day Shift, 7:00am-3:30pm

PURPOSE OF POSITION:

The primary purpose of the Benefit Plan Technical Specialist is to maintain groups and plans in the claims payment system (QNXT). The Benefit Plan Technical Specialist will accomplish this goal by working with Retention and Underwriting departments to obtain approved plan benefit information.

RESPONSIBILITIES & EXPECTATIONS:

Modifies or implements new configurations to the software system/operating system. (QNXT)
Recommends and implements configuration changes to improve the overall efficiency of system/claims processing.
Build and maintain sponsor information in the QNXT operating system to allow proper Billing, Member Enrollment, Claims processing, and file imports/extracts.
Build and maintain benefit plans and policies as defined by the benefit checklists provided by Retention/Sales.
Maintain and develop configuration to improve claims auto adjudication, based on the varying benefit plan designs, within the claims operating system.
Provide notice of new group configuration and plan completion to appropriate departments.
Document, tracks and image configuration changes.
Claims processing required to develop and execute test plans to verify that benefit plans and configuration changes work as intended.
Troubleshooting on reported issues involving a wide variety of processes and/or configuration in the claims administration system
Meet or exceed department quality standard for accuracy
History Maintenance and/or history transfer
Manually calculate benefit accumulations and claim adjustments specific to varying plan designs
Interpret and configure varying plan designs including medical, dental, vision, disability, HRA and Flex plans
Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
Seeks supervisory guidance/approval as appropriate.
Portrays professional image follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
Promotes and demonstrates professional standards to enhance the development of the department. Practices ethical conduct.
Meets acceptable attendance and punctuality expectations (excluding FMLA)

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and are not a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such accommodation.

QUALIFICATIONS:

Education: High School diploma or GED required; some college preferred
Knowledge of medical coding desired
Knowledge of claims administration preferred but not required
Knowledge of health care industry a plus
Exceptional communication and organizational skills
Effective skills in problem identification, research, analysis and resolution
Work well with others on assigned projects (team player)
Desire to contribute to a variety of roles within the department
Detail oriented
Able to multi-task and prioritize work without direct supervision
Proactive, self-motivated and maintain a positive attitude
Experience with Microsoft Office preferred
Experience with QNXT operating software by Cognizant is desired.

WORKING CONDITIONS:

Hours of operation are 7:30 AM to 5:00 PM, Monday through Friday, of which an eight-hour shift or flex schedule is assigned. Occasional overtime may be necessary.
Work from home upon completion of initial training.
Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.
Occasionally walking, standing, twisting/turning and reaching upward or forward during workday.
Sitting/walking intermittently during working hours. Computer use and frequent use of telephone.

AultCare is an Equal Opportunity Employer (EOE) that values and respects the importance of a diverse and inclusive workforce. It is the policy of the company to recruit, hire, train and promote persons in all job titles without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, protected veteran status or disability. We recognize that diversity and inclusion is a driving force in the success of our company. AultCare is an Equal Opportunity Employer that will make reasonable accommodation to enable individuals with disabilities to apply and compete for employment opportunities for which they are qualified. To request an accommodation, please email our Human Resources department at kbricker@aultcare.com , or call 330-363-6388, for further assistance.

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Job Summary

Employment Type:: Full Time Employee
Job type:: Federal Contractor
Skill Based Partner:: No
Education Level:: High school graduate
Work Days:: Mon, Tue, Wed, Thu, Fri
Job Reference Code: 79277847
Salary: N/A
Licenses / Certifications:: N/A; Applied Math: 5; Graphic Literacy: 5; Workplace Documentation: 5

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BENEFIT PLAN TECHNICAL SPECIALIST

Aultcare Corp. - Canton, OH

Job Description

Job Summary