Benefits Configuration Specialist in Orange at Prospect Medical Systems

Date Posted: 8/2/2019

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

Benefits Configuration Specialist

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

This position configures the financial risk matrix for each health plan into the IDX system, as well as configuring all aspects of Health Plan Benefit information setup, analysis, mapping, testing, troubleshooting and implementation.  The position is responsible for the daily operational activities which will ensure successful and accurate configuration of financial risk, as well as coverage and member cost share information per health plan.  Position is a liaison to Claims, Customer Relations, HMO Risk, Provider Dispute Resolution, Eligibility, Provider Relations and Claims Recovery regarding Financial Risk and Benefit Interpretation issues.

Job Responsibilities/Duties

  • Responsible for all aspects of Benefit configuration including interpretation, analysis, implementation and audit. Apply member cost share and benefit exclusion information from health plan evidence of coverage into IDX.
  • Set up and review test claims to ensure benefit configuration working as designed.
  • Audit Benefits configured by team members for Medicare Advantage plans, high membership Commercial plans and Commercial plans that are used to copy from for unique set of benefits.
  • Assists in the research and resolution of Benefit and Financial Risk inquires submitted by the Claims Department, the Customer Service Department and other departments within established time frames.
  • Responsible for managing Access Databases used for housing various health plan benefits; and managing various monthly processes. Utilize IDX Plan Upload Utility and Access & Excel to implement plan changes.
  • Assist in completion of major projects.  Define, develop, drive and deliver assigned small projects.


Minimum Education: High School degree or Associate preferred.

Minimum Experience: Minimum two to three (2-3) years of related experience.

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law:

Keywords: Configuration, Benefits, IT,  IDX