Benefit Plan Configuration Specialist - Plan Build
Centivo · Remote
About this role
**Benefit Plan Configuration Specialist – Plan Build** ## About Centivo Centivo exists to bring **affordable, high-quality healthcare** to the millions who struggle to pay their healthcare bills—supporting both **workers and their employers**. ## Summary of the Role As a **Benefits Plan Configuration Specialist**, you will **understand, translate, and configure medical and dental plan designs** into the core claims platform to ensure **accurate claims processing**. You’ll continuously evaluate current processes and business needs alongside system capabilities, and build **logic sets** (based on code mapping) with a strong focus on **accuracy and proficiency**. ## Responsibilities - Create the **blueprint** for plan configuration from plan documents and/or plan standards - Build, validate, and test **medical and dental plan benefits** and associated **code mapping logic** - Make plan building and logic revisions when plans are amended - Build **auto-adjudication logic** and test integration with the plan - Resolve system issues and act as a contact for opening/closing jobs on the core claims platform job list - Test open jobs on new releases and troubleshoot prior to production loading - Troubleshoot system problems, develop resolutions, and/or “work around” procedures - Partner with Department Managers, Team Leaders, and others to improve company efficiency - Coordinate solutions for system issues that prevent automated/standard processing - Communicate changes to other departments and support required training for system updates - Maintain the **claim system Plan Building mailbox** to research and resolve system issues ## Qualifications ### Required Skills & Abilities - Knowledge of **professional and institutional claims adjudication** - Ability to interpret plan documents/amendments and translate benefits to **ICD-10, HCPCS, CPT, CDT**, and other billing codes - Strong customer service skills: research and resolve configuration-related issues **timely and accurately** - Ability to adapt in a constantly changing environment - Strong organization; ability to work independently, problem-solve, and make decisions - Ability to work in a fast-paced, agile environment with multiple priorities and production deadlines - Collaborative mindset; ability to influence across functional teams - Proficiency in **Microsoft Office** and other web-based software - Ability to learn new proprietary computer systems ### Education & Experience - Prior experience with **highly automated and integrated claim adjudication systems** - Prior experience in a **start-up environment** is a plus ### Preferred Qualifications - **4–5 years** of health insurance Plan Building experience with **TPA and Self-Funding** processes - Associate’s or Bachelor’s degree preferred ## Work Location - Ideal candidate assigned to the **Buffalo Office** with ability to work from home - **Remote or hybrid** ## Centivo Values - **Resilient** — no easy button for healthcare affordability; mission-driven perseverance - **Uncommon** — building something better because the status quo isn’t working - **Positive** — caring, supportive, and generous with kudos and feedback ## Who We Are Centivo is an innovative health plan for **self-funded employers**. Anchored around a primary care-based **ACO model**, Centivo helps employers save **15–30%** compared to traditional insurance carriers. Employees benefit from **free primary care (including virtual)**, **predictable copays**, and **
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