The Opportunity
The Manager of Plan Build and Benefit Configuration leads the team responsible for the design, build, implementation, and ongoing configuration of benefit plan adjudication rules and claim workflow and routing. This role ensures accuracy, compliance, and operational excellence across all claims processes while maintaining ownership of data integrity within the claims adjudication system. The Manager provides strategic direction, supports companywide initiatives, and will serve as the primary subject matter expert for plan build and configuration.
This role will spend time performing hands-on plan build and benefit configuration work which includes system setup, benefit mapping, testing, and validation, while dedicating time to leadership, oversight, cross functional coordination, and continuous improvement efforts and reports directly to the Director, Claims Operations. This position can be supported remotely.
What you’ll do
- Lead and develop the Plan Build and Benefit Configuration team, setting expectations, guiding performance and ensuring quality execution across all confirmation activities and deliverables.
- Forecast staff needs and hire, onboard, and train talent.
- Serve as the SME for Plan benefit configuration logic and regulatory requirements interpretation
- Perform plan build and configuration work, ensuring accuracy, proper testing and adherence to standards.
- Establish and enforce policies, standard operating procedures, and best practices in order to deliver results that are consistent, accurate, and compliant with regulatory and operational requirements.
- Define key performance indicators and targets and reports results to leadership. Provide quantitative and qualitative analysis to explain results and design and implement improvements.
- Identify and address cross departmental impacts to unique benefit design requests to ensure the client and member have a seamless experience.
- Lead the solutioning and documentation of options to address complex configuration requests.
- Support enterprise planning and make recommendations that balance client needs with claims platform capabilities, data integrity, and operational stability.
- Drive improvements in configuration workflows, system functionality, testing processes, and start to finish adjudication logic to enhance quality, scalability, and efficiency.
- Effectively partner with Employer Services, IT, Member Experience, and external vendors to ensure alignment of configuration outcomes
What we expect from you
- 5 to10 years of Plan Build, Benefit configuration and Healthcare leadership experience
- 3+ years of business and operations experience in a health plan environment
- 2 to 3 years of Virtual Benefit Administer (VBA) experience
- 1 to 2 years of TPA experience
- Must have working knowledge in revenue codes and medical terminology.
- Experience with commercial health plan design
- Ability to delegate and adapt to changing circumstances and unexpected challenges in remote work environments.
- Proactive problem solving skills
- Excellent written and verbal communication skills
- Ability to make sound judgments based on the information available
- Reporting and analytical skills
- High School diploma or equivalent
We make healthcare EZ!
Additional Opportunity Details:
Target Base Compensation Range for this role is $95,000 to $125,000*
*Factors that may be used to determine your actual salary include your job specific skills, education, training, job location, number of years of experience related to this role and comparison to other employees already in this role. *
Employee benefits are part of the competitive total rewards package that HealthEZ provides to you. Our comprehensive benefits program includes health benefits, retirement plan (401k), paid time off, paid leave including parental leave and more.
HealthEZ recognizes its responsibilities under federal, state and local laws requiring nondiscriminatory employment practices. All employment decisions, practices and procedures will be carried out without regard to race, color, creed, religion and sex (including pregnancy), sexual orientation, national origin or ancestry, age, marital status, disability, family status, status with regard to public assistance or any other characteristic protected under applicable local, state and federal laws.
HealthEZ is proud to be an equal opportunity employer.
Skills Required
- 5 to 10 years of plan build, benefit configuration, and healthcare leadership experience
- 3+ years of business and operations experience in a health plan environment
- 2 to 3 years of Virtual Benefit Administer (VBA) experience
- 1 to 2 years of TPA experience
- Working knowledge of revenue codes and medical terminology
- Experience with commercial health plan design
- Ability to delegate and adapt to changing circumstances in remote work environments
- Proactive problem solving skills
- Excellent written and verbal communication skills
- Ability to make sound judgments based on available information
- Reporting and analytical skills
- High School diploma or equivalent
What We Do
We're your healthcare champion. For over 35 years we’ve been simplifying healthcare for our clients, brokers, providers and members. Our knowledgeable and service-oriented team creates and administers custom health benefits solutions that are EZ and affordable.
