Plan Building Specialist

ASR Health Benefits is a rapidly growing third-party administrator of health plans, including medical, dental, vision, short-term disability, Section 125 and consumer-directed health plans.  We administer these health plans through dedicated client service teams, consisting of staff members from each department at ASR who work together to meet our clients’ needs.

ASR is currently seeking a Plan Building Specialist to join our Operations Technology Department. We offer a dynamic work environment with opportunities for professional growth and development. At ASR, we follow a remote or hybrid work structure, allowing employees to work remotely and/or from the office based on specific tasks or personal work preferences.

Job Summary:

Plan Building Specialists design and configure complex benefit plans within a dedicated software system, translating client needs into specific plan structures, including coverage details, copays, deductibles, and benefit limits, ensuring compliance with regulations and accurately implementing these plans within the QicLink platform. 

Plan Building Specialists are responsible for the configuration, maintenance and troubleshooting of plan designs (inclusive of medical, dental, vision and disability) to enable the prompt, accurate processing and administration of self-funded benefit plans.  The Plan Building Specialist consistently looks for opportunities to leverage capabilities within QicLink to increase automation and work with the business to resolve issues with plan design.

Key Responsibilities:

• Interpret plan design requirements in the form of internal memos and plan documents to design, build, maintain and validate self-funded benefit plans.
• Contribute to the design, build and deployment of overall changes to plan design methodology leading to greater automation in the processing and administration of claims.
• Ensure plan design and implementation adhere to all relevant state and federal regulations, including ACA mandates.
• Research and resolve internal questions about plan design and function.
• Assist in the development and delivery of documentation and training surrounding new plan designs, new configuration and new methodologies internally to support their implementation.
• Serve as a resource for internal questions related to plan design, plan implementation and/or the systems’ application of plan design.
• Participate in regular core platform upgrade testing and implementation.
• Other tasks as assigned.

Preferred Qualifications:

• Excellent communicator with the demonstrated ability to understand and articulate the complexities of benefit plan designs, claims adjudication and system configuration verbally and in writing.
• 3+ years of health insurance experience as a medical claim analyst (or, preferably, as a plan builder of benefit configuration specialist).  Experience to include claims adjudication and/or system/plan configuration for self-funded plans for a variety of plan designs.  (QicLink is preferred but not required)
• High level of accuracy required when inputting plan details and reviewing configurations.
• Ability to analyze client needs, translate them into effective plan designs, and identify potential issues with plan structures.
• Familiarity with industry code sets including ICD 10, HCPCS, CPT, CDT, etc.
• Familiarity with regulations pertaining to the health insurance industry (HIPAA, ACA, CAA, ERISA, COBRA, CAQH CORE, etc.)
• Demonstrated ability to problem solve.
• Independent self-starter with the ability to manage competing priorities and deadlines.
• Experience in Microsoft Office and data analysis.
• Solution oriented.
• A strong appetite for continued learning.

To apply, please visit www.asrhealthbenefits.com and navigate to the CAREERS link on the homepage or send your resume with a cover letter to Plan Building Specialist, Human Resources, ASR health benefits, 618 Kenmoor Ave. SE, Suite 200 Grand Rapids, MI 49546 or fax to 616.464.4463.

No agencies please.