Lead Plan Build Specialist

Personify Health

10d•$26 - $35

About The Position

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future. Ready to Architect Complex Benefit Plans That Power Accurate Claims Processing? Why This Role Matters The Lead Plan Building Specialist is the technical architect who translates complex benefit plan designs into functional claim processing configurations that directly impact thousands of members' healthcare experiences. Your expertise in interpreting Summary Plan Descriptions and converting them into precise system logic ensures that every claim is paid accurately according to plan specifications and regulatory requirements. By serving as a subject matter expert, training team members, and continuously optimizing configuration logic, you safeguard the integrity of our claims operations while enabling other departments to resolve complex processing issues. Your work is the foundation that ensures members receive the benefits they're entitled to—no more, no less.

Requirements

Bachelor's degree or equivalent combination of education and experience
5 years experience working for TPA building benefit plans and pricing arrangements
Prior team leader or supervisor experience
Strong understanding of Javelina claim processing system
Ability to interpret and translate Summary Plan Descriptions (SPDs) into system logic and rule sets
Knowledge of provider and contract configuration
Expertise in identifying and troubleshooting claim discrepancies using SPDs, provider contracts, regulatory requirements, and claims-related resources
Proficiency in testing and auditing claim payment accuracy against benefit plan designs

Responsibilities

Build complex benefit configurations: Analyze plan designs, benefit policies, and pricing arrangements, providing rigorous interpretation and translation into benefit configurations within claim processing system.
Configure contract methodologies: Translate provider contract terms and payment arrangements into claim payment system logic ensuring accurate reimbursement processing.
Review system updates: Evaluate documentation regarding updates and changes to member enrollment, provider contracts, benefit plan designs, claim processing guidelines, and system configuration requirements.
Serve as technical expert: Act as subject matter expert for Personify claim systems, providing guidance and support to internal departments on complex claim processing issues.
Train and develop team: Lead training programs for Plan Builders, sharing expertise in system configuration, plan interpretation, and troubleshooting methodologies.
Optimize claims processes: Evaluate efficiency and reliability of claims processes through regular review and optimization of configuration logic for continuous improvement.
Ensure payment accuracy: Test and audit claim payment accuracy against benefit plan designs and contract information to maintain processing integrity and compliance.
Support cross-functional needs: Function as technical resource to other internal departments for resolving complex claim processing issues and system questions.

Benefits

Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life, not the other way around
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable
Competitive base salary that rewards your success
PTO policy because rest and recharge time is non-negotiable
Benefits effective day one—because you shouldn’t have to wait to be taken care of