Junior Plan Builder

About us

Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. We are part of an international healthcare group with more than 35 years of industry experience, and we're fully integrated with our long-term partners, who are recognized as industry leaders. ABA is a certified “Great Place to Work”, united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence, ABA is committed to delivering connected, transparent, and innovative healthcare solutions to employers and members across the United States.

Position Summary

We are seeking a highly motivated and analytical Junior Plan Builder to oversee the creation, maintenance, and improvement of plan benefit setups within our medical, dental, vision, and disability claims processing software. The ideal candidate is a collaborative team player with strong technical proficiency, excellent communication skills, and previous problem-solving experience in technical or customer support. In this role, you will leverage your multitasking abilities and analytical listening skills to provide timely, effective support and build strong cross-functional relationships. This role is a good fit if you are passionate about helping others, dedicated to elevating team success, and eager to actively learn and expand your technical knowledge base.

Duties and Responsibilities

• Creates new plan benefit set-ups by reviewing and interpreting the plan document supplied as the plan benefits for a new group
• Works with marketing and legal department personnel to determine the system's capability to support proposed new benefits or plan provisions
• Maintains existing plan benefit set-ups based on amendments or new plan documents for existing groups
• Creates PPO set-ups based on the plan document for new groups
• Maintains PPO plan benefit set-ups based on amendments or new plan documents for existing groups
• Creates, maintains, and improves PPO and network plan benefit set-ups
• Maintains knowledge of the claims processing software and researches methods of improving claims processing by utilizing system features
• Maintains PPO and network set-ups and codes in group master files
• Covers PPO and network maintenance and provides assistance to the individual(s) maintaining provider records in the system
• Investigates problems represented by claims examiners or auditors, identifies problems, and codes corrections within the system
• Complies with all privacy and confidentiality laws in the course of business
• Contributes to the daily workflow with regular and punctual attendance
• Aids in provider and PPO maintenance
• All month end and year end processes in WLT
• Performs other functions as assigned as business conditions change

Minimum Qualifications (Knowledge, Skills, and Abilities)

• Bachelor’s degree or equivalent combination of education and experience
• 3–5+ years of experience in health insurance/benefits administration, claims processing, or plan build/configuration within a TPA, insurance carrier, or managed care setting
• Hands-on experience configuring benefit plans and PPO/network set-ups in WLT
• Demonstrated ability to read, interpret, and translate plan documents, SPDs, and amendments into system-based benefit configurations
• Strong communication and ability to work cross-functionally with marketing, legal, underwriting, or provider relations teams to evaluate system capabilities for new or proposed benefit designs
• Strong analytical and problem-solving skills with attention to detail in a high-accuracy, compliance-driven environment
• Proficiency working in WLT is required
• Skilled in Microsoft Office Suite, with intermediate-level Excel skills

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

Work Environment

The noise level in the work environment is usually low to moderate.

Travel Requirements

10% for Annual WLT Conference and occasional travel to OKC Office/Dallas Office