Dallas, Texas
Posted: 13-Jun-25
Location: Remote,
Categories:
Internal Number: 25009201
About Us
Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.
Our Core Values are:
- We serve faithfully by doing what's right with a joyful heart.
- We never settle by constantly striving for better.
- We are in it together by supporting one another and those we serve.
- We make an impact by taking initiative and delivering exceptional experience.
Benefits
Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:
- Eligibility on day 1 for all benefits
- Dollar-for-dollar 401(k) match, up to 5%
- Debt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more
- Immediate access to time off benefits
At Baylor Scott & White Health, your well-being is our top priority.
Note: Benefits may vary based on position type and/or level
Job Summary
100% Remote position
The Benefit Configuration Analyst examines configuration change requests. They establish the technical scope, impact on systems, and required modifications. Accountable for designing, writing, testing, training, documenting, and implementing configurations to meet customer needs.
The pay range for this position is $25.14/hour (entry level qualifications) - $42.11/hour (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience.
Essential Functions of the Role
- Execute the build and implementation of benefit plan adjudication rules
- Coordinate the integration or conversion of new clients and / or products as needed
- Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components
- Develop best practices and standard operational procedures for creating and configuring benefit plans
- Establish consistency and standardization as it relates to tools and processes (deliverable templates, change management processes, business models, process flows, etc.)
- Ability to execute testing to ensure the accurate configuration of business requirement
- Analyze larger sets claims data to evaluate patterns of billing as it relates to benefit design and configuration
- Partner with claim processors, member service and provider service to identify and resolve issues related to the plan configuration
- Maintains assigned subsystem.
- Monitors existing system functionality and makes recommendations, where appropriate, to maintain acceptable levels of performance, reliability, and end user satisfaction.
- Utilizes system development lifecycle methodology to implement system changes to production environments.
- Installs, checks quality, and tests system configurations, software changes, and upgrades. Ensures accuracy, completeness, and compatibility of changes.
- Ensures the quality and integrity of work requests through the use of production validation and audit strategies.
- Researches complex problems to find possible solutions. Designs and implements solutions to help key business targets. This includes developing design requirements and technical specifications.
- Creates complex design documents by assessing requirements. Assesses design alternatives and chooses the best solution for business needs. Considers interdepartmental impact when recommending solutions.
- Serves as an internal consultant and subject matter expert. Participates on cross-functional teams and projects. Troubleshoots inquiries and issues from other departments.
- Develops, maintains, and disseminates internal and external configuration documentation, including status updates. Prepares procedural and customer documentation when required.
- Perform other duties as assigned
Key Success Factors
- Two years of benefit configuration experience strongly preferred (new products, authorization requirements, commercial/government/ASO lines of business).
- Experience with Health Edge's HealthRules Payer claims management software strongly preferred.
- Experience with benefit configuration & claim analysis strongly preferred.
- Broad operational managed care background preferred.
- Previous training and documentation experience preferred.
- Exceptional data, problem-solving and project management skills.
- Able to perform complex business and product requirement study.
- Demonstrates a high level of skill in data investigation and query tools like MS-Access, SQL, and MS-Excel to find root-cause issues.
- Knowledge and expertise of medical benefit policies and plan designs, claims hospital and medical processing, and adjudication with data skills.
- Working knowledge of CPT-4, ICD-10-CM, and general medical terminology.
- Excellent relational skills, including the ability to work with all levels of personnel.
Belonging Statement
We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.
QUALIFICATIONS
- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualifications
EXPERIENCE
- 2 Years of Experience