Are you a detail-oriented problem solver with a deep understanding of healthcare benefits and claims? We are looking for a Plan Specialist to act as the technical backbone of our Account Management team. In this role, you won't just be answering questions—you’ll be the subject-matter expert who ensures our clients and brokers receive accurate, compliant, and timely information. You will work behind the scenes to research complex inquiries, streamline internal processes, and empower our Account Managers to deliver world-class service.

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What the Plan Specialist can expect:

Strategic Inquiry & Claim Management

  • Expert Research: Manage the intake and resolution of inquiries regarding claims, benefits, precertification, and eligibility.
  • Cross-Functional Collaboration: Partner with internal departments (Claims, Customer Service, Eligibility) to gather accurate data and resolve issues efficiently.
  • Communication Design: Craft clear, concise, and compliant responses for Account Managers to deliver to clients and brokers.

 

Operational Excellence

  • Ticket Lifecycle: Oversee the creation, tracking, and resolution of service tickets, ensuring every interaction is documented with precision.
  • Trend Analysis: Identify recurring issues or “pain points” and escalate trends to leadership to drive process improvements.
  • Quality Assurance: Ensure all resolutions align with specific benefit designs, eligibility rules, and regulatory guidelines.

 

Account Manager Support

  • Subject Matter Resource: Serve as the “go-to” expert for Account Managers to help them navigate complex client issues.
  • Knowledge Transfer: Maintain constant communication with the AM team to ensure external messaging is consistent and accurate.

 

What the ideal Plan Specialist candidate would bring:

  • Associates or similar 2-year degree required
  • 2+ years in healthcare administration, claims, or insurance brokerage support preferred.
  • Exceptional research skills and the ability to translate “insurance-speak” into clear, professional communication.
  • A continuous improvement mindset—you’re always looking for a way to make a process faster or better.
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