Benefit Operations Specialist (Healthtech)

TL;DR

Benefit Operations Specialist (Healthtech): Managing benefit configuration and claims testing for medical and pharmacy programs with an accent on quality assurance and operational efficiency. Focus on optimizing plan setup, coordinating with product teams, and ensuring regulatory compliance.

Location: Must be based in the United States (Remote, Denver, CO, or New York, NY)

Salary: $75,000 - $90,000 USD

Company

An enterprise health technology company providing a comprehensive suite of pharmacy and health benefit management solutions through its proprietary Enterprise Health Platform.

What you will do

• Lead all aspects of benefit configuration, including new plan setup, changes, and regular audits.
• Collaborate with product and development teams to ensure client customized requests are configurable.
• Develop and execute batch testing scenarios to validate claim accuracy against benefit designs.
• Create standard policies, procedures, and training materials for cross-functional teams.
• Partner with leadership to align plan designs with client requests and regulatory requirements.
• Troubleshoot benefit-related discrepancies and errors during client go-live phases.

Requirements

• Must be based in the United States
• 5+ years of TPA or health plan experience in Medical Benefit configuration, testing, and claims monitoring.
• Bachelor’s degree preferred.
• Exceptional written and verbal communication skills.
• Tremendous attention to detail and ability to work in a high-paced, deadline-driven environment.
• Experience with structured/unstructured data in Excel and SQL.

Nice to have

• 3+ years of experience with Cigna.
• Pharmacy, Dental, or Vision benefit experience.
• Knowledge of self-funded plans, Medicare/Government programs, and ERISA.
• IFEBP certification.
• Familiarity with Agile methodologies.

Culture & Benefits

• Opportunity to influence operational best practices within a first-of-its-kind Integrated Benefits team.
• Contribution to rebuilding trust and infrastructure in the U.S. healthcare system.
• Inclusive work environment that celebrates diversity and equal employment opportunities.
• Flexibility between remote work and office locations in Denver or New York.