Benefit Plan Builder

17 hours ago

Manila, National Capital Region, Philippines Staff4Me Full time

We are seeking a highly skilled and detail-oriented Benefit Plan Builder to configure and maintain client benefit plans using the RIMS processing system. This role is critical to ensure accurate and automated claims adjudication. As a "super user" of RIMS, you'll collaborate with management and IT, troubleshoot processing issues, test software releases, and support special projects tailored to client needs.

Responsibilities

Plan Setup & Administration


• Build new group and product plans in RIMS, including run-in plans


• Use internal tools and checklists to ensure accurate configuration

Plan Design Review


• Analyze plan documents, amendments, policies, and mandates


• Recommend improvements for system-based adjudication

Documentation & Reporting


• Maintain records of active plan build tasks


• Document processing notes, exception codes, and upload finalized

data

Renewals, Amendments & Rewrites


• Manage benefit changes and test updates before finalizing


• Freeze/release updates in RIMS based on approvals

Compliance Monitoring


• Implement benefit changes per group policies and state regulations

Claim Support


• Respond to claims inquiries and troubleshoot system issues


• Manage mailbox and make necessary RIMS updates

Plan Testing & Auditing


• Conduct system testing and peer audits to ensure plan accuracy

Collaboration & Communication


• Communicate updates to departments (ID cards, billing, consultants)


• Coordinate with other plan builders and attend meetings

Training & Support


• Train internal teams on new or updated plans using documentation

System Optimization


• Work with IT to enhance RIMS functionality and share improvements

Special Projects & Provider Arrangements


• Collaborate on provider contracts and automate processing


• Document and train others on unique arrangements

Other Duties


• Support reporting, special assignments, and tasks from management

Technical & Industry Knowledge


• Experience with QicLink or VBA platforms


• 2–3 years of RIMS system experience


• 1–2 years of plan building experience


• 4–6 years of high-level claims processing and benefit knowledge


• Reinsurance and contract knowledge (specific & aggregate)


• Familiarity with federal laws affecting self-funding


• Medical terminology and coding proficiency

Core Competencies


• Strong problem-solving and multitasking abilities


• Excellent written and verbal communication, especially technical

writing


• Mathematical proficiency and attention to detail


• Ability to work independently and collaboratively


• Reliable, punctual, flexible, and emotionally mature


• Initiative-driven, with leadership potential and composure under

pressure


• Professional and respectful team player

Schedule: Monday to Friday, 8:00 AM – 6:00 PM E.S.T | 8PM-6AM PHT

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