Plan Coder

Plan Coding

• Verify new and existing plans loaded on the company’s claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments.
• Respond to work orders received from examiners to investigate plan issues and irregularities.
• Evaluate testing requests for all new plans prior to loading them into the production system.

Administrative

• Create and document a minimum of one new Standard Operating Procedure (SOP) annually.
• Identify, initiate and implement at least one process improvement and/or innovation annually.
• Maintain detailed log of plans that are currently being coded and in the process of being loaded.
• Send confirmations to internal stakeholders when applicable plans have been loaded.
• Work with programmers to test claims and related system programs to verify impact within the Health Care Processing System (HCPS).

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members.
• Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.

Physical Demands/Work Environment

• The physical demands and work environment described here represent those that an employee must meet to perform this job’s essential functions successfully.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• This noise level in the work environment is usually moderate.