Plan Building Specialist

hace 1 mes


Barrio de Guadalupe del Mezquitillo, Guanajuato, México Scalepex A tiempo completo

At Scalepex, we're committed to reshaping the way businesses harness talent globally. As a Plan Building Specialist, you'll play a crucial role in our mission to connect businesses with top-tier professionals from around the world.

Job Summary

The Plan Building Specialist is responsible for the build and maintenance of plan benefits for new and existing groups upon implementation, renewal, and changes. This role requires a strong working knowledge of medical billing and coding, as well as experience with self-funded health plans.

Main Responsibilities

  • Support Implementation and Account Management teams by consolidating information during new client implementation and/or renewal to ensure the accuracy of benefits.
  • Translate benefits from ICD10, HCPCS, CPT, CDT, and other insurance billing codes.
  • Configure benefits in claims processing systems.
  • Generate benefits summaries, at a group level, for internal and external use in supporting member and provider understanding of available benefits.
  • Ensure compliance with applicable government regulations.
  • Audit plans build work of other teammates.
  • Process Group terminations, as needed.
  • Correspond with account managers, account coordinators, claims department, and other technical areas.
  • Troubleshoot claims errors and refer escalated issues to team lead or manager.
  • Support on-boarding and training of new team members.

Requirements

  • 2+ years of experience in the healthcare field, claims or benefits strongly preferred.
  • Experience with self-funded health plans strongly preferred.
  • Strong working knowledge of medical billing and coding and/or medical claims processing.
  • High school diploma or general education degree (GED).
  • Highly organized, detailed-oriented, and deadline-driven.
  • Ability to read and interpret documents and instructions, short correspondence, and memos.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
  • Ability to deal with problems involving several concrete variables in standardized situations.
  • Strong communications skills to effectively interact with various teams.

  • Plan Building Specialist

    hace 4 semanas


    Barrio de Guadalupe del Mezquitillo, Guanajuato, México Scalepex A tiempo completo

    Job Title: Plan Building SpecialistAbout the Role:We are seeking a skilled Plan Building Specialist to join our team at Scalepex. As a Plan Building Specialist, you will be responsible for building and maintaining plan benefits for new and existing groups upon implementation, renewal, and changes.Main Responsibilities:Support Implementation and Account...

  • Plan Building Specialist

    hace 2 semanas


    Barrio de Guadalupe del Mezquitillo, Guanajuato, México Scalepex A tiempo completo

    About the Role:The Plan Building Specialist will play a critical role in the build and maintenance of plan benefits for new and existing groups upon implementation, renewal, and changes. This position requires a strong working knowledge of medical billing and coding, as well as experience with Self-funded health plans.Key Responsibilities:• Consolidate...


  • Barrio de Guadalupe del Mezquitillo, Guanajuato, México Scalepex A tiempo completo

    We are seeking a highly organized and detail-driven Strategic Plan Benefits Specialist to join our team at Scalepex.About ScalepexScalepex is a dynamic services firm specializing in providing nearshore solutions. We empower organizations to thrive in a rapidly evolving digital landscape by connecting them with top-tier professionals from around the world.Job...


  • Barrio de Guadalupe del Mezquitillo, Guanajuato, México Scalepex A tiempo completo

    At Scalepex, we are committed to creating a dynamic work environment that fosters collaboration, efficiency, and growth.We value diversity and believe in creating teams with various backgrounds, experiences, and perspectives. Diversity inspires innovation and challenges us to produce better solutions.**Job Overview**The Plan Building Specialist will be...

  • Claims Specialist

    hace 1 semana


    León de los Aldama, Guanajuato, México Gga Solutions A tiempo completo

    Claims Specialist Opportunity in PueblaWe are seeking a highly motivated and organized Claims Specialist to join our team in Puebla, Mexico. As a Claims Specialist, you will be responsible for handling personal US insurance claims involving car accidents and weather-related events.This is a full-time position with a salary range of $36,000.00-$37,000.00 per...

  • Environmental Specialist

    hace 4 semanas


    León de los Aldama, Guanajuato, México Michelin A tiempo completo

    Key Responsibilities:The Environmental Specialist will be responsible for managing and developing the Environment domain on the site.Identify external and internal requirements of the domain, including regulatory watch and prescriptions, and propose action plans based on gap analyzes to guarantee the site's compliance with regulations and internal...

  • Compliance Specialist

    hace 4 semanas


    León de los Aldama, Guanajuato, México Rijk Zwaan A tiempo completo

    Job SummaryRijk Zwaan is seeking a highly skilled Compliance Specialist to join our team. As a Compliance Specialist, you will play a crucial role in ensuring the company's compliance with all relevant laws and regulations.Key Responsibilities• Update documents and procedures related to legislation compliance• Supervise the water treatment plant...


  • León de los Aldama, Guanajuato, México Rijk Zwaan Italia S.R.L. A tiempo completo

    Job Title: Compliance SpecialistWe are seeking a highly skilled Compliance Specialist to join our team at Rijk Zwaan Italia S.R.L. As a Compliance Specialist, you will play a crucial role in ensuring our company's compliance with local legislation and regulations.Key Responsibilities:Update and maintain documents and procedures related to operating licenses,...


  • León de los Aldama, Guanajuato, México Sqa Services A tiempo completo

    At Sqa Services, we're seeking a skilled Quality Assurance Specialist to join our team. This part-time contract position will have you working hand-in-hand with the building blocks of 'the cloud'.Key Responsibilities:Perform quality control activities, including visual, physical, and dimensional inspection of machined, electro-mechanical, and other parts,...


  • León de los Aldama, Guanajuato, México Rust Belt Home Buyers A tiempo completo

    Rust Belt Home Buyers is a dynamic real estate investment company seeking an experienced Commercial Property Acquisitions Specialist to join our team. We offer a competitive salary of $60,000 - $80,000 per year.As a key member of our acquisitions team, you will be responsible for identifying and securing new properties for our portfolio. Your primary focus...


  • León de los Aldama, Guanajuato, México Colgate-Palmolive A tiempo completo

    Quality Assurance SpecialistThe Quality Assurance Specialist is responsible for ensuring that all projects meet the highest quality and safety standards. This involves coordinating with the project engineer and plant quality departments to execute the project validation process.Key Responsibilities:Prepare and execute project qualification...


  • León de los Aldama, Guanajuato, México Michelin A tiempo completo

    Michelin is seeking a highly skilled Automation Solutions Specialist to join its team. This role plays a crucial part in the development and implementation of automation solutions that drive business growth and improve efficiency.As an Automation Solutions Specialist at Michelin, you will be responsible for:Conducting feasibility studies to identify...

  • Medical Device Specialist

    hace 4 semanas


    León de los Aldama, Guanajuato, México Boston Scientific Corporation A tiempo completo

    **Job Summary**We are seeking a highly skilled Medical Device Specialist to join our team in Leon. As a Medical Device Specialist, you will be responsible for providing full support in interventional cardiology procedures, developing deep knowledge of our products, therapies, and procedures, and carrying out the monthly and quarterly sales plan for the...


  • León de los Aldama, Guanajuato, México Here Technologies A tiempo completo

    **Accounts Payable Specialist Role:**We are seeking a highly skilled Accounts Payable Specialist to join our team at HERE Technologies. As an Accounts Payable Specialist, you will be responsible for reviewing and processing invoices based on purchase orders for several HERE companies. You will also run the weekly paycycles and perform the A/P month end...


  • León de los Aldama, Guanajuato, México Ebury A tiempo completo

    About the Role We are seeking a highly skilled Client Servicing Specialist to join our Ebury Institutional team. As a key member of our team, you will be responsible for providing exceptional customer service to our clients, ensuring their transactions and processes run smoothly and safely on our platform.Key Responsibilities Client Support: Provide timely...


  • León de los Aldama, Guanajuato, México The Timken Company A tiempo completo

    Supply Chain Operations SpecialistAt The Timken Company, we're looking for a skilled Supply Chain Operations Specialist to join our team. As a key member of our supply chain team, you will be responsible for ensuring 100% on-time delivery to customer promise. This involves analyzing and coordinating the necessary supply chain activities to meet inventory...


  • León de los Aldama, Guanajuato, México Siemens Energy A tiempo completo

    About the RoleWe are seeking a skilled Customs Specialist to join our team in Mexico. This role involves supporting customs processing and coordination of all import/export operations performed by Siemens Energy MX (air, land, sea & rail).The successful candidate will ensure adherence to corporate and legal record retention policies, implement and...


  • León de los Aldama, Guanajuato, México Sanmina Corporation A tiempo completo

    **Job Description for Senior Financial Planning Specialist at Sanmina Corporation** The ideal candidate will have 4 years of experience in finance and costs management, with expertise in Excel, Oracle, and MS Office. Strong analytical and problem-solving skills are essential, along with excellent English communication skills (written and spoken)....


  • León de los Aldama, Guanajuato, México Bosch A tiempo completo

    Job OverviewBosch is a leading technology company, driving innovation and progress for over 130 years. As an Assembly Technology Specialist - Robotics and Automation, you will play a crucial role in developing and implementing cutting-edge automation solutions.Salary InformationThe estimated annual salary for this position is $120,000-$150,000 based on...


  • León de los Aldama, Guanajuato, México Hsbc A tiempo completo

    Job Summary:- As a Global Payments Solutions Specialist at Hsbc, you will play a key role in providing expert knowledge of relevant products and services to clients.- This includes acting as a lead sales representative on opportunities with key clients and/or deals, consistently demonstrating the Sales Manager competencies and providing guidance and coaching...