Job Abstract

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.