PLAN BUILDER

About HealthSmart

HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that's just the beginning of our story - We make differences in peoples' lives every single day!

Our HealthSmart team understands the difference we make when treating others with dignity and respect, which is why we embody our mission by promoting a diverse and inclusive culture.

We're a company of innovators.

We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.

We provide care management services that change lives and helps employers and members take control of healthcare costs.

HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.

Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.

HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.

We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.

POSITION SUMMARY
The Plan builder will serve as the primary contact for vendors and third party administrators. Research, design, recommend and implement benefit plans that present the best value. Perform benefit plan audits and recommend cost reduction or containment strategies. Maintain records and procedures for the administration process. Provide customer support to both internal and external customers.

Implement systematic benefit building, which supports adjudication of claims in accordance with clients' benefit summary, plan document and requested requirements.

Essential Skills and Qualifications

• Working experience in Managed Care, TPA, and/or Healthcare environment
• Experience implementing systematic benefit plan building
• Proven ability to work with clients and vendors

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Analyze a variety of health benefits, including major medical, PPO, dental, disability and vision
• Complete, maintain and distribute benefit summaries for each plan change or new client installation
• Develop, implement, test and insure accuracy of benefit building for clients in accordance with provisions in the benefit summary and plan document ensuring maximum claim productivity and automation
• Maintain all required documentation
• Update/Maintain IVR set-up for assigned clients
• Utilize the assistance of a Senior Plan Builder or Team Manager if needed

Physical Requirements

• While performing the duties of this job, the employee is frequently required to sit, talk, and hear.
• The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms.
• The employee must occasionally lift and/or move up to 30 pounds.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.
• The work is performed primarily in an office setting.
• The noise level in the work environment is moderate

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position

HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.