Technical Benefit Plan Build Specialist (Insurance)

Job Description

Job Description

Overview
VAULT Strategies is seeking a Technical Benefit Plan Build Specialist (Benefit Configuration Analyst)to configure, implement, troubleshoot, and maintain benefit plans within our healthcare claims administration platform.

This is a highly technical role responsible for translating complex benefit plan documents into accurate system configurations that drive claims adjudication. The successful candidate will serve as the subject matter expert for benefit configuration, ensuring the plan builds function correctly within the claims administration system while supporting ongoing maintenance, testing, troubleshooting, and optimization.

The ideal candidate has hands-on experience configuring healthcare benefit plans within a claims administration platform for a health plan, TPA, or insurance carrier. This individual understands how benefit configuration impacts claims processing and enjoys solving complex benefit and claims issues.

Required Qualifications

• 5+ years of hands-on Benefit Configuration or Plan Build experience within a healthcare claims administration system.
• Experience working as a Benefit Configuration Analyst, Benefit Configuration Specialist, Plan Builder, or similar technical configuration role.
• Experience configuring healthcare benefit plans for a TPA, insurance carrier, health plan, or benefits administrator.
• Strong understanding of healthcare claims adjudication and how benefit configuration impacts claim payment.
• Experience interpreting Summary Plan Descriptions (SPDs), plan documents, schedules of benefits, and plan amendments.
• Ability to troubleshoot claim payment issues by analyzing benefit configuration and system logic.
• Strong analytical, technical, and problem-solving skills.
• Exceptional attention to detail and quality assurance mindset.
• Ability to manage multiple implementations and configuration projects simultaneously.

Preferred Qualifications

• Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field.
• Experience supporting self-funded employer health plans.
• Experience working with TPAs, captives, or commercial health insurance carriers.
• Experience with benefit implementation, plan conversions, and system migrations.
• Knowledge of healthcare regulations affecting benefit administration.
• Experience participating in User Acceptance Testing (UAT), regression testing, and system validation.
• Experience supporting automation or rules-based claims adjudication.

What Success Looks Like

• Benefit plans are configured accurately and implemented on schedule.
• Claims adjudicate correctly based on plan intent and documented benefit rules.
• Configuration-related claim issues are identified and resolved quickly.
• Plan build documentation is complete, standardized, and repeatable.
• Cross-functional teams rely on you as the technical expert for benefit configuration and claims logic.