Southwest Services Administrators

Healthcare Benefit Plan Builder

US-AZ-Phoenix
2 weeks ago(1/11/2018 5:39 PM)
Job ID
2018-1103
# of Openings
1
Category
Data Analysis Team

Overview

Southwest Service Administrators is a Third Party Administrator (TPA) providing unique and specialized administrative services to labor-management Trust Funds (primarily) in the southwest United States with offices in Phoenix, AZ (our corporate service center), Albuquerque, NM and Salt Lake City, UT since 1995.

 

We offer competitive wages and an excellent benefit package including FULL FAMILY coverage for medical, dental, vision & Rx. Other benefits include (employee) short & long term disability, Life/AD&D Insurance, 401k, Pension, generous Paid Personal & Vacation Leave policy and career advancement and travel opportunities.

 

Southwest Service Administrators is currently hiring an experienced Healthcare Benefit Plan Builder.  The focus of this position is support operational healthcare data management with emphasis on medical, dental and vision plan building.

Responsibilities

  • Assists with benefit implementations for new and existing clients.
  • Analyzes Supporting Plan Documents and sets up claims paying system accordingly.
  • Assists with system modifications and enhancements; testing system changes and communicating resolutions to users.
  • Manages claim routing criteria and workflow through the claims paying system.
  • Assists with claim auto adjudication set-up and maintenance.
  • Assists with analyzing data storing procedures and making modifications and enhancements as needed.
  • Provides support and technical guidance for system users, including help desk ticket resolution.
  • Other duties as assigned.                                                                                                                       

Qualifications

  • Strong Medical Terminology knowledge.
  • Experience with plan benefit set-up and maintenance.
  • Understanding of EDI ANSI X12 transactions and workflow including 835’s and 837’s.
  • Experience with Basys Claims System is a plus.
  • Willingness to learn technology quickly through instruction, collaboration, and self-learning.
  • Ability to read and comprehend detailed technical instructions, vendor correspondence, and other technical information.
  • Strong independent research and analytical skills.
  • Ability to deal professionally with different types of personalities, having strong verbal and written communication skills.
  • Must be able to work extended hours as needed.

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