Job Description
Job Description
Health Plans, Inc. (HPI) is a New England-based Third-Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security.
Summary:
The Plan Building Specialist is responsible for new business set up, renewal updates and day-to-day maintenance of data within the Javelina System required to provide accurate claim processing and administration of benefits. This position is also responsible for training in these procedures.
Duties and Responsibilities (other duties may be assigned): - Responsible for installation of new business as well as renewal process for in force business
- Benefit Plan Building
- Adjudication Logic Building
- Maintain Benefit Code, Pend Reason Code, Denial Code, Provider Specialty, EOB Message Code Tables
- Maintain Benefit Cross Reference Table
- Maintain Diagnosis Cross Reference Table
- Build Pricing Contracts as necessary
- Research and resolve Claim processing questions through TRU Workflow Queues
- Research and resolve patient benefit accumulator issues for claims examiners
- Benefit plan testing for new business
- Perform other various tasks that are deemed necessary and equitable by Technical Resource Manager
Education Requirements:
- High School diploma or equivalent
Experience Requirements:
- Plan Building Specialists are required to successfully complete training sessions as outlined by the Technical Resource Manager.
- Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint.
Why choose us?
- Our space is a reflection of who we are—innovative, open and collaborative.
- Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
- We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks.
- Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
- We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
- We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.
Benefits
We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our team:
- Medical, Dental and Vision Coverage
- Prescription Drug Coverage
- Fitness Reimbursement Benefit
- Tobacco Cessation Program
- Employee Assistance Program
- Flexible Spending Account & Health Savings Account
- 401(k) and Profit-Sharing Plan
- Quarterly Bonuses
- Generous Paid-Time Off
- Volunteer Days
- Education Assistance & Professional Development Opportunities
- ….and much much more!
So, think you want to join the HPI team? We hope to hear from you!
You can read more about us at hpitpa.com/about-us/careers/
EEO/AA/M/F/Vet/Disability Employer