Lead Plan Build Specialist

Overview

Who We Are

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

Ready to Architect Complex Benefit Plans That Power Accurate Claims Processing?

Why This Role Matters

The Lead Plan Building Specialist is the technical architect who translates complex benefit plan designs into functional claim processing configurations that directly impact thousands of members' healthcare experiences. Your expertise in interpreting Summary Plan Descriptions and converting them into precise system logic ensures that every claim is paid accurately according to plan specifications and regulatory requirements. By serving as a subject matter expert, training team members, and continuously optimizing configuration logic, you safeguard the integrity of our claims operations while enabling other departments to resolve complex processing issues. Your work is the foundation that ensures members receive the benefits they're entitled to—no more, no less.

What You'll Actually Do

Build complex benefit configurations: Analyze plan designs, benefit policies, and pricing arrangements, providing rigorous interpretation and translation into benefit configurations within claim processing system.

Configure contract methodologies: Translate provider contract terms and payment arrangements into claim payment system logic ensuring accurate reimbursement processing.

Review system updates: Evaluate documentation regarding updates and changes to member enrollment, provider contracts, benefit plan designs, claim processing guidelines, and system configuration requirements.

Serve as technical expert: Act as subject matter expert for Personify claim systems, providing guidance and support to internal departments on complex claim processing issues.

Train and develop team: Lead training programs for Plan Builders, sharing expertise in system configuration, plan interpretation, and troubleshooting methodologies.

Optimize claims processes: Evaluate efficiency and reliability of claims processes through regular review and optimization of configuration logic for continuous improvement.

Ensure payment accuracy: Test and audit claim payment accuracy against benefit plan designs and contract information to maintain processing integrity and compliance.

Support cross-functional needs: Function as technical resource to other internal departments for resolving complex claim processing issues and system questions.

Qualifications

What You Bring to Our Mission

Education & Experience:

• Bachelor's degree or equivalent combination of education and experience
• 5 years experience working for TPA building benefit plans and pricing arrangements
• Prior team leader or supervisor experience

Technical Skills:

• Strong understanding of Javelina claim processing system
• Ability to interpret and translate Summary Plan Descriptions (SPDs) into system logic and rule sets
• Knowledge of provider and contract configuration
• Expertise in identifying and troubleshooting claim discrepancies using SPDs, provider contracts, regulatory requirements, and claims-related resources
• Proficiency in testing and auditing claim payment accuracy against benefit plan designs

Why You'll Love It Here

We believe in total rewards that actually matter—not just competitive packages, but benefits that support how you want to live and work.

Your wellbeing comes first:

• Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
• Mental health support and wellness programs designed by experts who get it
• Flexible work arrangements that fit your life, not the other way around

Financial security that makes sense:

• Retirement planning support to help you build real wealth for the future
• Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
• Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage

Growth without limits:

• Professional development opportunities and clear career progression paths
• Mentorship from industry leaders who want to see you succeed
• Learning budget to invest in skills that matter to your future

A culture that energizes:

• People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
• One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
• We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
• Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable

The practical stuff:

• Competitive base salary that rewards your success
• PTO policy because rest and recharge time is non-negotiable
• Benefits effective day one—because you shouldn’t have to wait to be taken care of

Ready to create a healthier world while building the career you want? We're ready for you.

No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you.

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $26.00 to $35.00 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for medical, dental, vision, and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to [email protected]. All of our legitimate openings can be found on the Personify Health Career Site.