United States onlyThis position is posted by Jobgether on behalf of a partner company. We are currently looking for a Benefit Design and System Support Analyst REMOTE in United States.
In this role, you will support benefit design operations and ensure the accuracy and efficiency of claim processing across multiple internal systems. You will act as a key resource for troubleshooting, resolving system-related inquiries, and maintaining benefit configuration quality for both new and existing clients. Working closely with implementation, clinical, EDI, account management, and programming teams, you will help drive improvements in system reliability, audit accuracy, and documentation standards. This position requires strong problem-solving abilities, attention to detail, and adaptability in a fast-evolving environment. Your work will directly support consistent service delivery and enhance the overall experience for internal teams and external stakeholders.
Accountabilities:
- Provide expertise on claim processing systems, addressing inquiries and resolving issues submitted through the ticketing system.
- Adjudicate information across multiple platforms and enforce internal procedures established by leadership.
- Identify, correct, and audit benefit design errors, evaluating financial impact and presenting findings to Account Management and leadership when needed.
- Facilitate benefit design setup for new clients and collaborate with Implementation, EDI, and Clinical teams to clarify requirements and ensure accurate configurations.
- Support updates for ongoing clients by obtaining documentation, coordinating changes, and assisting Customer Service Representatives with claim-related questions.
- Partner with external programming teams to analyze and resolve system programming errors.
- Participate in internal quality assurance initiatives and ensure consistent application of checks and balances within claims processing procedures.
- Adhere to HIPAA requirements, report violations appropriately, and maintain all required compliance training.
- Adapt to evolving duties and responsibilities as needed in a dynamic environment.
Requirements
- Associate or Bachelor’s degree preferred, with 2–3 years of experience in PBM, health plan, pharmacy chain, or managed care environments focused on systems or plan design.
- Intermediate to advanced proficiency with MS Excel, Word, PowerPoint, and Outlook.
- Strong organizational, time management, and problem-solving skills with a detail-oriented approach.
- Excellent communication and collaboration abilities, able to work effectively across multiple teams.
- Comfort working with new technologies, learning quickly, and adapting to changing processes and requirements.
- Ability to work full time Monday–Friday with occasional after-hours or weekend responsibilities, in a remote or onsite setting.
Benefits
- Medical, dental, and vision insurance.
- Disability and life insurance coverage.
· Employee Assistance Program.
· Generous paid time off.
- Annual reviews and development plans.
- Retirement plan with immediate 100% vesting and employer match.
- Remote work flexibility for eligible employees.
Jobgether is a Talent Matching Platform that partners with companies worldwide to efficiently connect top talent with the right opportunities through AI-driven job matching.
When you apply, your profile goes through our AI-powered screening process designed to identify top talent efficiently and fairly.
🔍 Our AI evaluates your CV and LinkedIn profile thoroughly, analyzing your skills, experience and achievements.
📊 It compares your profile to the job’s core requirements and past success factors to determine your match score.
🎯 Based on this analysis, we automatically shortlist the 3 candidates with the highest match to the role.
🧠 When necessary, our human team may perform an additional manual review to ensure no strong profile is missed.
The process is transparent, skills-based, and free of bias — focusing solely on your fit for the role.
Once the shortlist is completed, we share it directly with the company that owns the job opening. The final decision and next steps (such as interviews or additional assessments) are then made by their internal hiring team.
