Plan Benefit Analyst

About the role

Reflect Health is the evolution of S&S Health, a trusted independent third-party administrator founded in 1994 to meet the growing need for access, simplified connectivity, and benefits administration. Headquartered in Mason, OH, we have built a reputation based on innovation, service excellence, and a deep understanding of how to drive better outcomes at lower cost. Over the years, we grew into a national presence serving employers, TPAs, health systems, and benefit consultants across all 50 states. We developed proprietary claims technology, expanded our offerings to include level-funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members. The Plan Benefit Analyst is responsible for analyzing, interpreting, and supporting the administration of health and welfare benefit plans. This role reviews plan documents, benefit specifications, and related materials to understand how benefits are intended to operate and helps ensure those provisions are accurately reflected in claims administration systems and business processes. The Plan Benefit Analyst works closely with internal teams to research benefit questions, interpret plan provisions, validate benefit configurations, investigate claims-related issues, and support the implementation and maintenance of client benefit plans. The role requires strong analytical and problem-solving skills, attention to detail, and the ability to translate complex benefit information into clear and practical solutions. This position does not involve software programming or coding. It requires the ability to understand benefit plan design, identify how plan provisions should be administered, and work effectively with systems and business partners to support accurate benefit administration.

Responsibilities

• Benefit Plan Analysis: Review and analyze medical, dental, vision, and other benefit plan designs, specifications, and requirements to understand how benefits should be administered.
• Plan Document Interpretation: Review Summary Plan Descriptions (SPDs), plan documents, benefit summaries, amendments, and other supporting documentation and interpret applicable plan provisions.
• Benefit Research: Research complex benefit questions involving eligibility, coverage, limitations, exclusions, deductibles, coinsurance, out-of-pocket requirements, accumulators, and other plan provisions.
• Claims Support: Research claims and benefit-related issues to determine whether claims have been administered consistently with applicable plan provisions and identify potential discrepancies.
• System Validation: Work with Plan Build and other system teams to validate that benefit plan configurations accurately reflect plan documents and specifications.
• Benefit Configuration Support: Translate benefit plan requirements into clear specifications and provide guidance regarding how plan provisions should be represented within claims administration systems. This role does not involve software coding.
• Testing & Validation: Participate in testing of new and modified benefit plans, review test results, identify discrepancies, and work with appropriate teams to resolve issues before implementation.