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SYSTEM CONFIGURATION SPECIALIST Job in Canton, Ohio US

SYSTEM CONFIGURATION SPECIALIST

Aultcare Corp. - Canton, OH

Posted: 7/12/2021 - Expires: 10/10/2021

Job ID: 229392034

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Job Description

Req# 18733

Aultman Health Foundation, CANTON, OH

AULTCARE ADMINISTRATION

Aultman Health Foundation

Full Time, Day Shift, 8a-4:30p







PURPOSE OF POSITION:

The primary purpose of the Plan Builder is to maintain groups and plans in the claims payment system.  The Plan Builder will accomplish this goal by working with Marketing and Underwriting departments to obtain approved plan benefit information. 

 

RESPONSIBILITIES & EXPECTATIONS:

* Establish and maintain group controls in the claims administration system

* Establish and maintain plan controls, including the auto adjudication controls, based on varying plan designs in the claims administration system

* Provide notice of new group and plan completion to appropriate departments

* Conduct benefit meetings with appropriate departments to review new plans and plan changes

* Test plan set up to ensure accuracy prior to releasing (this includes processing test claims)

* Quality assessment using internal audit process

* Internal support for all departments within the organization

* Troubleshooting on reported issues involving a wide variety of programs in the claims administration system

* Meet or exceed a set quality standard for accuracy 

* History Maintenance and/or history transfer

* 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 including:

o Performs all job functions in an independent manner (as needed or directed)

o Recognizes and performs job functions with little or no supervision

o Demonstrates strong organizational skills

o Responds positively to change in work flow as needed

o Offers assistance to co-workers (as needed)

o Maintains flexibility to meet department needs, including adjusting work hours

o Consistently completes assigned work in required time frame; completes other duties as required

o Collaborates and cooperates with co-workers, supervisors, etc., creating a productive working relationship throughout the organization

o Actively seeks and pursues opportunities to make a contribution and demonstrates desire for learning

* Practices Ethical Conduct:

o Demonstrates honesty and integrity in all functions and relationships

o Maintains AultCare standards of confidentiality, including HIPAA privacy guidelines

o Complies with policies and procedures at all times

* Meets acceptable attendance and punctuality expectations (excluding FMLA)

 

* Meets acceptable quality and productivity measures as designated by the Technical Support department Manager.

 

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as 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, sexual orientation, gender identity, national origin, disability, or veteran status. 

 

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 an 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 an accommodation. 

 

QUALIFICATIONS:

* High School graduate

* Claims processing experience required

* Effective skills in problem identification, research, analysis and resolution

* Ability to comprehend and interpret varying plan designs including medical, dental, vision, disability, HRA and Flex plans

* Desire to contribute in a variety of roles within the department

* Must work well with others on assigned projects (team player)

* Exceptional communication skills

* Must be detail oriented

* Must be dependable and reliable (excellent attendance required)

* Must be able to multi-task and prioritize work without direct supervision

* Must be proactive, self-motivated and maintain a positive attitude

* Must have the ability to manually calculate benefit accumulations and claim adjustments specific to varying plan designs

* Experience with Microsoft Office preferred

 

WORKING CONDITIONS:

* Hours of operation, day shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.

* Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.

* Sitting/standing/moving about intermittently during working hours.

* Subject to frequent interruptions and changes in priority of duties throughout the day.

 

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.

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
57436148
Salary
N/A
Licenses / Certifications:
N/A
Display Recommended WorkKeys®Recommended WorkKeys®:
N/A