Benefit Plan Builder

We are seeking a highly skilled and detail-oriented Benefit Plan Builder to configure and maintain client benefit plans using the RIMS processing system. This role is critical to ensure accurate and automated claims adjudication. As a “super user” of RIMS, you’ll collaborate with management and IT, troubleshoot processing issues, test software releases, and support special projects tailored to client needs.

Responsibilities

Plan Setup & Administration

• Build new group and product plans in RIMS, including run-in plans

• Use internal tools and checklists to ensure accurate configuration

Plan Design Review

• Analyze plan documents, amendments, policies, and mandates

• Recommend improvements for system-based adjudication

Documentation & Reporting

• Maintain records of active plan build tasks

• Document processing notes, exception codes, and upload finalized

data

Renewals, Amendments & Rewrites

• Manage benefit changes and test updates before finalizing

• Freeze/release updates in RIMS based on approvals

Compliance Monitoring

• Implement benefit changes per group policies and state regulations

Claim Support

• Respond to claims inquiries and troubleshoot system issues

• Manage mailbox and make necessary RIMS updates

Plan Testing & Auditing

• Conduct system testing and peer audits to ensure plan accuracy

Collaboration & Communication

• Communicate updates to departments (ID cards, billing, consultants)

• Coordinate with other plan builders and attend meetings

Training & Support

• Train internal teams on new or updated plans using documentation

System Optimization

• Work with IT to enhance RIMS functionality and share improvements

Special Projects & Provider Arrangements

• Collaborate on provider contracts and automate processing

• Document and train others on unique arrangements

Other Duties

• Support reporting, special assignments, and tasks from management

Technical & Industry Knowledge

• Experience with QicLink or VBA platforms

• 2–3 years of RIMS system experience

• 1–2 years of plan building experience

• 4–6 years of high-level claims processing and benefit knowledge

• Reinsurance and contract knowledge (specific & aggregate)

• Familiarity with federal laws affecting self-funding

• Medical terminology and coding proficiency

Core Competencies

• Strong problem-solving and multitasking abilities

• Excellent written and verbal communication, especially technical

writing

• Mathematical proficiency and attention to detail

• Ability to work independently and collaboratively

• Reliable, punctual, flexible, and emotionally mature

• Initiative-driven, with leadership potential and composure under

pressure

• Professional and respectful team player

Schedule: Monday to Friday, 8:00 AM – 6:00 PM E.S.T | 8PM-6AM PHT