Dual Entry Plan Builder

Dual Entry Plan Builder

Requirements

• 1 year healthcare industry experience with benefits interpretation
• High School Diploma or GED

Responsibilities

• Provides plan benefit review, interpretation and systematic setup essential for online viewing and processing related to Customer Service, Claims, Enrollment, Billing and Reporting in support of internal and external partners.
• Reviews benefit provisions to ensure compliance with state and federal mandates.
• Develops and executes implementation strategy consistent with client expectations; Ensures strategy is administered in accordance with all performance guarantee arrangements.
• Uses critical thinking and extensive knowledge of Meritain’s system and processes to evaluate impact of client requested exceptions and develops reasonable alternatives to satisfy client’s needs while minimizing impact on Meritain’s system and operations.
• Identifies, communicates and tracks cost sensitive items not included as part of the standard process and highlights them for consideration in the determination of rate adjustments or renewal activity.
• Collaborates on review, analysis and development of recommendations for the design of complex account and benefit structures based on customers’ objectives and Meritain’s system.
• Ability to utilize Meritain’s proprietary system for analytical coding of detailed customized plans rather than standard offerings.
• Effectively manages implementation and provides direction to fellow team members ensuring success of overall implementation process.
• Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation.
• Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.).
• Demonstrates Salesforce proficiency and understanding for cross functional communication and executive level status reporting.
• Reviews coverage files at intervals throughout the first year of implementation to analyze for setup adjustments to align with claim processing reports to achieve higher levels of auto adjudication opportunities.

Preferred Qualifications

• Customer Service, Claims, and or Plan Build preferred
• Salesforce experience preferred
• Detail oriented
• Highly organized
• Good communication skills