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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical and dental plan benefits configuration, including the ability to interpret plan documents and translate benefits to relevant billing codes. Proficient in troubleshooting system issues and collaborating with cross-functional teams to enhance operational efficiency.
Highest-signal resume keywords
Claims AdjudicationICD 10 CodingCPT CodingMicrosoft Office ProficiencyPlan Building Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Plan ConfigurationAuto-Adjudication LogicCode-Mapping LogicSystem TroubleshootingClaims ProcessingInsurance Billing CodesAgile Environment AdaptabilityProblem-SolvingDecision-MakingResearching Configuration Issues
Soft Skills
Customer Service SkillsOrganizational SkillsCollaborationInfluencing OthersAdaptability
Tools & Technologies
Core Claims PlatformWeb-Based Software Applications
Industry Keywords
Health InsuranceTPA ProcessesSelf-Funding ProcessesPlan DocumentsAmendments
About the role
Key responsibilities & impact- Create plan-configuration blueprints from plan documents and/or plan standards
- Build, validate, and test medical and dental plan benefits and associated code-mapping logic
- Revise plan builds and logic when plans are amended
- Build auto-adjudication logic and test integration with plans
- Resolve system issues and manage opening and closing jobs on the core claims platform job list
- Test open jobs in new core claims platform releases and troubleshoot problems before production loading
- Troubleshoot system problems and develop resolutions or workaround procedures
- Work with Department Managers, Team Leaders, and other personnel to improve company efficiency
- Coordinate solutions for system-related issues that prevent automated or standard processing
- Communicate changes to other departments and support required training related to system changes
- Maintain the claim-system Plan Building mailbox to research and resolve system issues
Requirements
What you’ll need- Knowledge of professional and institutional claims adjudication
- Ability to interpret plan documents and amendments and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes
- Exemplary customer service skills for researching and resolving configuration-related issues
- Ability to adapt to a constantly changing environment
- Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions
- Demonstrated ability to work in a fast-paced, agile environment while managing multiple issues under production schedules and deadlines
- Demonstrated ability to work collaboratively and influence others across multiple functional teams
- Proficiency in Microsoft Office applications and other web-based software applications
- Ability to learn new proprietary computer systems
- Prior experience with highly automated and integrated claim adjudication systems
- 4 to 5 years of health insurance-related Plan Building experience with TPA and Self-Funding processes (preferred qualification)
- Prior start-up experience is a plus
- Associates or Bachelor’s degree preferred
- Authorized to work in the United States for any employer
- Centivo does not sponsor work authorization visas at initial hire or later during employment
Benefits
Comp & perks- Offers Equity
- Offers Bonus
- Ability to work from home
- Remote or hybrid work arrangement
- Free primary care (including virtual) for employees through Centivo’s benefit plan design
- Predictable copay and no-deductible benefit plan design