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Plan Building Specialist II at Healthcare Management Administrators. HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. . We are proud to say that for four years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.. What we are looking for:.  We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. . What you can expect:.  You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: . https://www.accesshma.com/. How YOU will make a Difference:.  . This role is responsible for the successful implementation and programming clients benefit plans, as setting up buy up products for our clients as well as managing third party vendor files. The importance of this role is to ensure benefits are correctly programmed and product services are readily available for members.. What YOU will do:  . ·       Review prior SPD’s and make recommendations for new group implementations, such as system capabilities and regulatory requirements, and present to new clients as needed. Ask clarifying questions about plan details that could be missing.. ·       Create and update plan summaries and program the claims system for simple and medium complexity client renewals and implementation of off-cycle benefit changes.. ·       With the assistance of the Plan Building Specialist II or III, assist with programming updates for clients with complex renewals.. ·       Assist with complex and escalated customer service issues to ensure resolution.. ·       maintaining the vendor file maintenance for buy-up products. This includes incoming/outgoing files, setting up SFRP and retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups.. ·       Work with vendor to ensure accurate EOB design and setup as needed.. ·       Review and respond to applicable TechOps Support tickets and MDI claims queries as needed.. ·       Assist Plan Building Specialist III with programming new group implementations as needed.. ·       Assist with complex and escalated customer service issues to ensure resolution.. ·       Retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups.. ·       Assist in training of Plan Building Specialist I team members. . ·       Review and respond to applicable TechOps Support tickets and MDI claims queries as needed.. ·       Conduct peer-to-peer audit for Plan Building team programming.. ·       High school diploma or equivalent experience required. ·       3-5 years of recent relevant experience . ·       Strong QicLink knowledge is beneficial for the programming of benefits in QicLink.  . ·       Strong analytical skills are crucial for translating client intent into programming of their benefits in QicLink.. ·       Comprehensive understanding of benefits that we administer and different plan types.. ·       Solid understanding of regulations that impact benefit design, including but not limited to, the Affordable Care Act, Mental Health Parity and IRS rules related to administration of high deductible health plans.. ·       Clear and effective verbal and written communication skills. . ·       Strong interpersonal skills and ability to work with team members at all levels.. Company Location: United States.