Plan Building Specialist II

Job Description

Job Description

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.

We are proud to say that for four years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

What we are looking for : We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.

What you can expect : You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work / life balance, and the ability to contribute to something important, find out more about us at : https : / / www.accesshma.com /

How YOU will make a Difference :

This role is responsible for the successful implementation and programming clients benefit plans, as setting up buy up products for our clients as well as managing third party vendor files. The importance of this role is to ensure benefits are correctly programmed and product services are readily available for members.

What YOU will do :

• Review prior SPD’s and make recommendations for new group implementations, such as system capabilities and regulatory requirements, and present to new clients as needed. Ask clarifying questions about plan details that could be missing.
• Create and update plan summaries and program the claims system for simple and medium complexity client renewals and implementation of off-cycle benefit changes.
• With the assistance of the Plan Building Specialist II or III, assist with programming updates for clients with complex renewals.
• Assist with complex and escalated customer service issues to ensure resolution.
• maintaining the vendor file maintenance for buy-up products. This includes incoming / outgoing files, setting up SFRP and retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups.
• Work with vendor to ensure accurate EOB design and setup as needed.
• Review and respond to applicable TechOps Support tickets and MDI claims queries as needed.
• Assist Plan Building Specialist III with programming new group implementations as needed.
• Assist with complex and escalated customer service issues to ensure resolution.
• Retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups.
• Assist in training of Plan Building Specialist I team members.
• Review and respond to applicable TechOps Support tickets and MDI claims queries as needed.
• Conduct peer-to-peer audit for Plan Building team programming.

Requirements

Knowledge, Experience, and Key Attributes needed for Success :

Benefits

The base salary for this position in the greater Seattle area is $108,000-$120,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available.

Disclaimer : The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.

In addition, HMA provides a generous total rewards package for full-time employees that includes :

How we Support your Work, Life, and Wellness Goals

At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.

We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)

HMA requires a background screen prior to employment.

Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA’s standard policies and procedures.

HMA is an Equal Opportunity Employer.

For more information about HMA, visit www.accesshma.com.