Plan Build Auditor (Health Plan Configuration)

Location: Fully remote within Minnesota, Minneapolis, MN 55439, USA

Salary: $75,000–$95,000 per year

Company

hirify.global provides healthcare benefits administration services and supports health plan configuration, claims processing, and related operational activities.

What you will do

• Review new and modified benefit plan configurations against approved requirements, plan documents, and configuration standards.
• Validate configuration outcomes through structured testing and claims adjudication review, including benefit structures, limitations, accumulators, cost shares, provider networks, pricing, denial logic, exception codes, and member responsibility indicators.
• Document audit findings, communicate recommendations, track resolutions, and perform follow-up reviews to confirm corrective actions.
• Configure and maintain benefit plans, interpret plan documents, and translate business requirements into system configuration.
• Support client implementations, benefit changes, system enhancements, regulatory updates, and operational testing initiatives.
• Analyze quality trends, strengthen controls, update procedures and testing standards, and provide actionable recommendations to improve configuration accuracy.

Requirements

• At least five years of experience in health plan configuration, claims administration, benefit plan operations, or a related healthcare environment.
• At least one year of VBA software knowledge.
• Knowledge of benefit plan design, claims adjudication, and configuration methodology.
• Experience interpreting plan documents and translating requirements into system configuration.
• Understanding of accumulators, limitations, exclusions, cost-share structures, and claim processing logic.
• Experience performing testing, validation, or quality review in a plan configuration environment.
• Strong analytical, problem-solving, organizational, written communication, and verbal communication skills, with excellent attention to detail and commitment to accuracy.
• Proficiency with Microsoft Excel and other business reporting tools.

Nice to have

• Two years of VBA software knowledge.
• Experience auditing benefit plan configurations or implementation deliverables.
• Experience within a health plan, third-party administrator, or healthcare payer environment.
• Knowledge of exception codes, claim messaging, and adjudication-related configuration.
• Experience supporting implementation projects and system enhancement initiatives.
• Associate's or Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field.

Culture & Benefits

• Fully remote position supported within Minnesota.
• Health benefits and retirement plan with 401(k).
• Paid time off and paid leave, including parental leave.
• Equal opportunity employment and compliance with applicable nondiscrimination laws.