It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
The Benefit Administration Program Specialist is responsible for the maintenance of departmental documentation, including, but not limited to; documentation creation, organization, and regulatory materials. This roles acts as a liaison for the department, supporting new process builds, program development as well as benefit configuration coding support. The Benefit Administration Program Specialist will collaborate with internal departments to define requirements and to document those requirements sufficiently to ensure accurate implementation of benefit rules within the Plan’s adjudication system.
Our Investment in You:
- Full-time remote work
- Competitive salaries
- Excellent benefits
Key Functions/Responsibilities:
- Support the Benefit Administration Team as the departmental liaison (e.g. Question triage, shepherding work between teams and delegating tasks within the team)
- Assist the Benefits Administration Manager on project management activities, which may include; change management, data analysis, stakeholder communication, benefit testing and technical implementations
- Update internal and external documentation with operational changes related to new mandates or contract changes with regulatory products (including all current and future products)
- Become a company-wide resource in terms of benefit-related questions, issues, etc. as needed
- Oversee (update and maintain) the coding matrix, along with the Benefit Categories for all products
- Update the Product Requirements Document with operational changes related to new mandates or contract changes with regulatory products (including all current and future products)
- Support the team with foundational departmental program builds (e.g., Benefit policy creation, UAT, Data analysis and reporting)
- Work with the Benefits Specialists to write and submit the IT requests, as well as monitor the prioritization of them with Configuration and ensure there is communication between affected departments, individuals, etc.
- Leads and participates in testing (UAT) for internal and external processes that interact with benefits and benefit policy
- Support, from a QC perspective, the data being displayed on the member/provider portals, external web-site, ID card descriptions, and other member-facing materials, reflecting any benefit or product-specific information that is created and maintained by Marketing
- Other duties as assigned
Qualifications:
Education Preferred:
- AAPC Coding Certification preferred, or coding experience either as a biller or payer
- A combination of training and experience acceptable
- Bachelor’s Degree preferred or the equivalent combination of training and experience acceptable
Experience Required:
- 1-2 years in the Healthcare industry, particularly in positions that are familiar with benefits, product and or regulatory compliance, and/or
- 1-2 years using data, and data analytics to support operational activities
Experience Preferred/Desirable:
- 3-5 years working with benefits configuration, or benefit coding
- 1-2 years’ experience building new programs
- 1-2 years’ experience in process improvement
- Experience working with Medicaid, Medicare and commercial coding rules/ regulatory requirements
- Documentation quality assurance (QA)
Competencies, Skills, and Attributes:
- Effective collaborative and proven process improvement skills
- Strong oral and written communication skills; ability to interact within all levels of the organization
- A strong working knowledge of Microsoft Office products
- Demonstrated ability to successfully plan, organize and manage projects
- Detail oriented, excellent proof reading and editing skills
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.
- WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.
Required Skills
Required Experience
