Benefit Plan Builder

<p>We are seeking a highly skilled and detail-oriented<strong> Benefit Plan Builder</strong> to configure and maintain client benefit plans using the RIMS processing system. This role is critical to ensure accurate and automated claims adjudication. <strong>As a “super user” of RIMS,</strong> you’ll collaborate with management and IT, troubleshoot processing issues, test software releases, and support special projects tailored to client needs.</p><p><strong> Responsibilities </strong></p><p><strong>Plan Setup &amp; Administration</strong></p><p>• Build new group and product plans in RIMS, including run-in plans</p><p>• Use internal tools and checklists to ensure accurate configuration</p><p><strong>Plan Design Review</strong></p><p>• Analyze plan documents, amendments, policies, and mandates</p><p>• Recommend improvements for system-based adjudication</p><p><strong>Documentation &amp; Reporting</strong></p><p>• Maintain records of active plan build tasks</p><p>• Document processing notes, exception codes, and upload finalized </p><p>data</p><p><strong>Renewals, Amendments &amp; Rewrites</strong></p><p>• Manage benefit changes and test updates before finalizing</p><p>• Freeze/release updates in RIMS based on approvals</p><p>Compliance Monitoring</p><p>• Implement benefit changes per group policies and state regulations</p><p>Claim Support</p><p>• Respond to claims inquiries and troubleshoot system issues</p><p>• Manage mailbox and make necessary RIMS updates</p><p><strong>Plan Testing &amp; Auditing</strong></p><p>• Conduct system testing and peer audits to ensure plan accuracy</p><p>Collaboration &amp; Communication</p><p>• Communicate updates to departments (ID cards, billing, consultants)</p><p>• Coordinate with other plan builders and attend meetings</p><p><strong>Training &amp; Support</strong></p><p>• Train internal teams on new or updated plans using documentation</p><p><strong>System Optimization</strong></p><p>• Work with IT to enhance RIMS functionality and share improvements</p><p>Special Projects &amp; Provider Arrangements</p><p>• Collaborate on provider contracts and automate processing</p><p>• Document and train others on unique arrangements</p><p><strong>Other Duties </strong></p><p>• Support reporting, special assignments, and tasks from management</p><p><strong>Requirements</strong></p><p><strong>Technical &amp; Industry Knowledge</strong></p><p>• Experience with QicLink or VBA platforms</p><p>• 2–3 years of RIMS system experience</p><p>• 1–2 years of plan building experience</p><p>• 4–6 years of high-level claims processing and benefit knowledge</p><p>• Reinsurance and contract knowledge (specific &amp; aggregate)</p><p>• Familiarity with federal laws affecting self-funding</p><p>• Medical terminology and coding proficiency</p><p><strong>Core Competencies </strong></p><p>• Strong problem-solving and multitasking abilities</p><p>• Excellent written and verbal communication, especially technical </p><p>writing</p><p>• Mathematical proficiency and attention to detail</p><p>• Ability to work independently and collaboratively</p><p>• Reliable, punctual, flexible, and emotionally mature</p><p>• Initiative-driven, with leadership potential and composure under </p><p>pressure</p><p>• Professional and respectful team player</p><p></p><p>Schedule: Monday to Friday, 8:00 AM – 6:00 PM E.S.T | 8PM-6AM PHT</p>