Plan Build Auditor

HealthEZ

. Review and validate new and modified benefit plan configurations against approved requirements, plan documents, and configuration standards .

Posted 10/24/2026full-timeRemote • Minnesota • United StatesMid-LevelSenior💰 $75,000 - $95,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in health plan configuration and claims administration, with a strong focus on benefit plan design, testing, and quality assurance. Proficient in translating business requirements into system configurations while maintaining accuracy and compliance with established standards.

Highest-signal resume keywords

Health Plan ConfigurationClaims AdministrationBenefit Plan DesignVBA Software KnowledgeAnalytical Problem-Solving

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Benefit Plan OperationsClaims AdjudicationConfiguration MethodologyTesting and ValidationQuality Review ActivitiesAccumulators UnderstandingCost-Share StructuresClaim Processing LogicAudit ProceduresDocumentation Maintenance

Soft Skills

Attention to DetailOrganizational SkillsEffective Communication

Tools & Technologies

Microsoft ExcelBusiness Reporting Tools

Certifications & Qualifications

Associate's DegreeBachelor's Degree

Industry Keywords

Healthcare AdministrationThird-Party AdministratorHealthcare PayerException CodesClaim Messaging

Tech Stack

Tools & technologies

VBA

About the role

Key responsibilities & impact

Review and validate new and modified benefit plan configurations against approved requirements, plan documents, and configuration standards
Validate system configuration outcomes through structured testing and claim adjudication review
Review benefit structures, coverage limitations, accumulators, cost-share arrangements, provider network configurations, pricing methodologies, denial logic, exception codes, member responsibility indicators, remit messaging, and claim processing outcomes
Document audit findings, communicate recommendations, and track resolution activities through completion
Perform follow-up reviews to validate corrective actions
Analyze audit findings and recommend improvements to configuration quality and consistency
Maintain audit documentation and support quality, accuracy, and implementation-readiness reporting
Configure and maintain benefit plans according to approved requirements and business specifications
Interpret plan documents and translate business requirements into system configuration
Support implementations for new and existing clients, benefit changes, and system enhancements
Participate in testing for configuration changes, system upgrades, regulatory updates, and operational initiatives
Serve as a resource for complex configuration scenarios and adjudication-related questions
Collaborate with cross-functional teams on implementation and operational performance
Promote configuration standards, procedures, and departmental best practices
Identify opportunities to strengthen quality controls and reduce configuration-related defects
Conduct ongoing trend analysis of audit findings and quality results
Provide feedback and recommendations to address recurring issues and improve configuration accuracy
Update audit procedures, testing standards, configuration guidelines, and related documentation
Partner with leadership and team members to improve operational efficiency, consistency, and quality outcomes
Participate in departmental initiatives and special projects

Requirements

What you’ll need

Minimum of five years of experience in health plan configuration, claims administration, benefit plan operations, or a related healthcare environment
At least 1 year of VBA software knowledge; 2 years preferred
Demonstrated knowledge of benefit plan design, claims adjudication, and configuration methodology
Experience interpreting plan documents and translating requirements into system configuration
Strong understanding of accumulators, limitations, exclusions, cost-share structures, and claim processing logic
Experience performing testing, validation, or quality review activities within a plan configuration environment
Strong analytical, problem-solving, and organizational skills
Excellent attention to detail and commitment to accuracy
Effective written and verbal communication skills
Proficiency with Microsoft Excel and other business reporting tools
Associate's or Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field preferred
Experience auditing benefit plan configurations or implementation deliverables preferred
Experience within a health plan, third-party administrator (TPA), or healthcare payer environment preferred
Knowledge of exception codes, claim messaging, and adjudication-related configuration preferred
Experience supporting implementation projects and system enhancement initiatives preferred

Benefits

Comp & perks

Health benefits
Retirement plan (401k)
Paid time off
Paid leave, including parental leave