Health Plan ASO Product Configuration & Benefits SME (Remote- EST Timezone))

Hello,

Good Morning,

I'm Rahul from Floga Technologies. We are a growing IT services organization delivering scalable technology solutions, and we are expanding our team with qualified talent.

We have an immediate opening for a Health Plan ASO Product Configuration & Benefits SME with strong hands-on experience to support a long-term engagement with our client. The candidate must collaborate effectively with cross-functional teams to deliver high-quality solutions.

Role: Health Plan ASO Product Configuration & Benefits SME

Location: Remote

Contract: 3-4months

Experience: 10+ Years

Ideally looking for someone based in the US, to work roughly EST hours.

Role purpose

The ASO Product Configuration & Benefits SME will lead the detailed definition and documentation of product, benefit, and configuration decisions required to launch a new ASO offering. This individual will work across Product, Benefits, Claims, Configuration, Operations, Technology, Clinical, Pharmacy, Network, Legal/Compliance, Sales, and vendor teams to translate high-level product strategy into specific product selections and implementable business requirements.

The resource should bring hands-on experience designing and configuring commercial health plan products-particularly ASO/self-funded products-and understand how benefit design decisions ultimately translate into claims administration and core platform configuration.

Key responsibilities

1. Drive detailed PADU/product selection working sessions (preferred / acceptable / discouraged / unacceptable)

1. Facilitate structured working sessions with Product and functional SMEs to define detailed ASO product decisions.
2. Decompose high-level product components into the specific decisions required for implementation: included services, optional services, eligibility, configuration choices, exclusions, exceptions, customization parameters, vendor selections and commercial treatment.
3. Bring leading-practice ASO product knowledge to identify decisions the organization may not know it needs to make.
4. Distinguish between standard product configuration, employer-selectable options, configurable parameters, and true exceptions/customizations.
5. Identify dependencies between benefit decisions and claims, network, pharmacy, clinical programs, eligibility, billing, reporting and vendor administration.
6. Maintain decision logs, open issues, dependencies and accountable owners.

2. Define the ASO benefits and configuration model

1. Define the detailed benefit architecture supporting the ASO product.
2. Document configurable benefit attributes including deductibles, coinsurance, copays, out-of-pocket maximums, accumulators, visit/service limits, network tiers, medical/Rx integration, exclusions and benefit-specific rules.
3. Establish the configuration hierarchy and guardrails-what is standard, selectable, configurable with approval, or outside the product.
4. Define employer/group-level configuration requirements and identify where configuration varies by group, plan, benefit package, network or population.
5. Help establish reusable benefit packages/templates rather than relying on one-off group configuration.
6. Identify implications for plan documents, SBCs, benefit summaries and other configuration-driven outputs.

3. Translate approved product decisions into detailed requirements

1. Convert approved PADU/product decisions into clear, testable business and functional requirements.
2. Document business rules, configuration logic, data requirements, process requirements, system impacts, integrations, controls and vendor dependencies.
3. Develop acceptance criteria and scenarios demonstrating how requirements should operate for different employer and member situations.
4. Trace requirements back to approved product decisions so implementation teams can distinguish product intent from implementation interpretation.
5. Partner with technology/configuration teams to ensure requirements contain sufficient detail for configuration and development.

4. Bridge Product and technical configuration teams

The person should be able to take a product statement such as: "Employers may select among three deductible levels with integrated medical/Rx accumulators and optional out-of-network coverage." and drive it down to the next level: permitted deductible values, individual/family logic, embedded versus aggregate rules, accumulator behavior, network applicability, Rx interaction, exception rules, group-level configuration attributes, claims-system implications, documentation requirements and acceptance criteria.

They would not be the person physically entering configuration into the claims platform, but they should have enough configuration experience to know what the downstream configurator needs.

Required experience

8 15+ years of commercial health plan experience, with significant hands-on experience in ASO/self-funded product implementation, benefits configuration, or claims configuration.

Strong candidates should have:

1. Deep knowledge of commercial medical benefit design and administration, including deductibles, OOP maximums, copays, coinsurance, accumulators, benefit limits, exclusions and network-tier logic.

2. Experience with ASO product configuration and employer-group customization, including understanding the substantially greater configurability required for self-funded business.

3. Hands-on experience translating benefit/product designs into configuration specifications or detailed requirements for claims-adjudication platforms.

4. Experience with at least one major payer core administration environment or equivalent configuration architecture; experience with platforms such as HealthRules, Facets, QNXT or similar would be valuable.

5. Strong understanding of interactions among benefits, claims, eligibility, network, pharmacy, clinical programs, stop loss, billing and employer reporting.

6. Experience developing configuration matrices, benefit specifications, business rules, requirements, use cases and acceptance criteria.

7. Experience facilitating detailed cross-functional requirements/design workshops with Product, Operations and Technology.

8. Ability to identify configuration implications and missing decisions rather than simply documenting what stakeholders tell them.

9. Strong documentation discipline and ability to maintain traceability from product decision business rule configuration/requirement acceptance criteria.

Ideal prior titles might include Director/Lead, Product Configuration; Benefits Configuration Lead; ASO Product Implementation Lead; Claims & Benefits Configuration SME; Senior Product Configuration Consultant; or Payer Product/Benefits Solution Architect.

What operational depth looks like for this role

Has worked on the implementation or configuration side of a payer, not just product strategy or benefits consulting. The resume should show time spent making plans actually run, not just designing or selling them.

Can explain what happens downstream of a benefit decision. If a candidate can only describe a deductible structure but not how it behaves in the claims platform, they don't have it.

Hands on with at least one core administration platform. Health Rules, Facets, QNXT or similar. They don't need to be the one keying in configuration, but they should have sat close enough to know what the configurator needs from them.

Real ASO or self-funded experience, not just fully insured. Self-funded is far more configurable at the employer group level, and that's where most of the complexity lives.

Has built the artifacts, not just reviewed them. Configuration matrices, benefit specs, business rules, use cases, acceptance criteria. Ask them to describe a document they personally owned.

Knows how benefits interact with everything around them. Eligibility, accumulators, pharmacy, clinical programs, network tiers, stop loss, employer billing and reporting. One decision touch all of these.

Has cleaned up after a bad configuration decision. The judgment about what should be a standard template versus an employer exception only comes from having maintained one off setups at renewal.

Can run a room. This person facilitates working sessions with Legal, Pharmacy, Network, Claims and Technology in the same meeting, and has to surface decisions nobody else thought to make.

Thanks & Regards,

Rahul H | Floga Technologies

Sr. Talent Acquisition Specialist
E: rahul