Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.
We are seeking a highly skilled and motivated addition to our Plan Building and System Configuration team to optimize auto adjudication processes across all systems. The ideal candidate will have hands-on experience in plan building, system configuration, and claims testing in the healthcare industry. This role requires a dynamic individual who can manage multiple systems, learn and integrate new technologies, and build and test updates to ensure efficient and accurate claims processing.
Primary Responsibilities:
- Develop, configure, and maintain healthcare plan designs and benefit configurations in various systems.
- Ensure all plan configurations support auto adjudication and meet regulatory and compliance requirements.
- Regularly review and update plan configurations to reflect changes in healthcare policies and regulations.
- Oversee the integration and interoperability of different healthcare systems to streamline auto adjudication processes.
- Facilitate system upgrades, patches, and maintenance to ensure seamless operation and minimal downtime.
- Collaborate with IT and other departments to implement new technologies and enhancements.
- Perform comprehensive testing of plan configurations to ensure accurate and efficient claims adjudication.
- Identify and resolve any discrepancies or issues in the adjudication process.
- Create and document testing protocols and procedures to maintain high standards of quality and accuracy.
- Work closely with internal and external stakeholders to gather requirements and ensure plan configurations meet organizational and client needs.
- Become a subject matter expert on plan building and system configuration, providing guidance and support to other departments.
- Communicate effectively with stakeholders to keep them informed of project status, issues, and resolutions.
- Maintain detailed documentation of all plan configurations, system changes, and testing procedures.
- Use data and analytics to identify trends, opportunities for improvement, and areas needing attention.
Qualifications:
- Associate’s degree in healthcare administration, information systems, or a related field.
- Minimum of 2 years of experience in plan building, system configuration, and claims adjudication in the healthcare industry.
- Strong knowledge of healthcare policies, regulations, and compliance requirements.
- Proficiency in using healthcare management systems and software.
- Excellent problem-solving skills and attention to detail.
- Effective communication and interpersonal skills.
- Ability to work in a fast-paced environment and manage multiple projects simultaneously.
- Experience with auto adjudication systems and technologies preferred.
- Certification in healthcare information systems or related fields preferred.
- Proven track record of successful system integration and optimization projects preferred.
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
- Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
Top Skills
What We Do
Point C is a National Third-Party Administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for your clients – and take you beyond the standard “Point A to Point B.”
Our TPA partners have decades of experience curating custom healthcare plans that simultaneously reduce healthcare spend for employers and help employees get the quality care they need.
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