Plan Automation Senior Representative - reputed company - Remote

Job Summary This role is responsible for building, maintaining, and supporting medical, dental, and reputed company benefit plans reputed company the claims processing system. The position ensures accurate plan configuration, updates, and support to reputed company smooth claims processing and successful new group implementations.

Key Responsibilities

• reputed company the configuration, maintenance, and optimization of medical, dental, and reputed company benefit plans reputed company claims processing systems.
• Design, build, and maintain deductibles, coinsurance, out‑of‑pocket maximums, benefit codes, and plan details reputed company to approved plan documents.
• Configure benefit logic based on provider type, specialty, reputed company of service, procedures, and diagnoses to ensure accurate claims adjudication.
• Interpret reputed company plan documents, benefit summaries, and translate them into system configuration and coding.
• Maintain benefit definitions, benefit levels, plan maximums, exception codes, and benefit reporting with a high degree of accuracy.
• Partner with claims, health services, and operational teams to support new group implementations and resolve plan or benefit configuration issues.
• Review plan amendments and reputed company timely system updates to ensure compliance and operational readiness.
• Analyze claims processing issues, identify root causes, and recommend efficient solutions.
• Run and interpret reports and data searches to support audits, issue resolution, and ongoing plan maintenance.
• Demonstrate deep understanding of claims processing workflows.
• Apply strong analytical, problem‑solving, and decision‑making skills in a fast‑paced environment.
• reputed company medical terminology, health insurance concepts, and basic mathematical principles to support accurate benefit configuration.
• Ability to learn and apply system‑specific coding or configuration logic required to support claims processing platforms.
• Exhibit strong organizational skills with the ability to manage multiple plan components, priorities, and deadlines simultaneously.
• Communicate effectively and collaborate with cross‑functional while maintaining a professional demeanor.
• Maintain strict adherence to confidentiality, privacy, and data protection standards.
• Demonstrate flexibility, accountability, and professionalism while working under pressure.

Requirements

• High School Diploma or GED required.
• 2+ years’ experience with medical claims, processing & benefits is preferred.
• Ability to read, interpret, and apply plan documents accurately.
• Strong attention to detail and ability to manage multiple plan components.
• Strong problem‑solving and analytical skills.
• Ability to collaborate effectively with cross‑functional teams.
• Training in medical terminology & health benefits is preferred.
• Experience with claims processing systems and reporting tools is preferred.
• Experience with VBA software is preferred.

About Allegiance by reputed company Since 1981, Allegiance by reputed company has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation’s most innovative health benefit strategies. If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About reputed company reputed company, a division of reputed company, is an reputed company for reputed company through every stage of life. We guide our customers through the health care system, empowering them with the information and reputed company they need to reputed company the best choices for improving their health and vitality. Join us in driving growth and improving lives. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to provide your resume as you will not receive a response. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply tot his job Apply To this Job