Responsibilities
- Analyze, configure, and maintain client benefit plan designs with a high degree of accuracy.
- Interpret business requirements and translate them into system configurations within the claims adjudication platform.
- Support new client implementations and ongoing updates for existing clients, including testing and validation of changes.
- Maintain clear and accurate documentation of system configurations and processes.
- Partner with internal teams to support client needs across claims, eligibility, accumulators, and reporting.
- Participate in projects and recommend process improvements to enhance operational efficiency.
- Perform quality assurance reviews to ensure configuration accuracy and compliance with standards.
- Troubleshoot and resolve issues proactively, minimizing escalation.
- Contribute to team performance by meeting service levels and individual accuracy/timeliness goals.
- Support knowledge sharing, training, and development of team members.
- Ensure compliance with regulatory and industry standards, including HIPAA and NCPDP.
Requirements
- Bachelor’s degree preferred or equivalent industry (i.e., healthcare or insurance) experience required.
- Prior experience with benefits and compiling analytical data and reports required.
- Background encompassing electronic claims processing preferred.
Benefits
- Best Employer: PDMI was voted Best Employer in Ohio for the 5th consecutive year in 2025!
- Meaningful Work: Contribute to improving healthcare quality and efficiency.
- Collaborative Environment: Work with passionate professionals who share your drive.
- Exciting Challenges: Every day brings new opportunities to excel.
- Flexible Work: Fully remote opportunity with a company that cares.
Additional Information
- All offers are contingent upon successful completion of a pre-employment background check, including employment and education verification, as well as a 4-panel drug screen.
