Palni Inc
Palni Inc

Health Plan ASO Product Configuration & Benefits SME- Remote- 6 Months

Remote • Posted 12 hours ago • Updated 12 hours ago
Contract W2
Contract Independent
Contract Corp To Corp
6 Months
No Travel Required
Remote
Depends on Experience
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Job Details

Skills

  • ASO
  • Self-Funded Health Plans
  • Health Plan Benefits
  • Benefits Configuration
  • Product Configuration
  • Claims Configuration
  • Commercial Health Plans
  • Claims Administration
  • Facets
  • QNXT
  • HealthRules
  • Payer Systems
  • Employer Group Customization
  • Medical Benefits
  • Business Requirements
  • Functional Requirements
  • Configuration Specifications
  • Healthcare Payer
  • Administrative Services Only.

Summary

Health Plan ASO Product Configuration & Benefits SME
Location: Remote
Contract: 6 Months
Work Hours: EST hours preferred
Experience: 8 –15+ years

Job Overview
We are looking for an experienced Health Plan ASO Product Configuration & Benefits SME to support the design and implementation of a new ASO (Administrative Services Only) / Self-Funded health plan offering.
The ideal candidate will have strong experience in commercial health plan benefits, ASO/self-funded products, benefits configuration, and claims administration. This role will bridge the gap between Product/Benefits teams and technical configuration teams by translating product decisions into detailed, implementation-ready business requirements.
Key Responsibilities
  • Lead working sessions with Product, Benefits, Claims, Operations, Technology, and other functional teams to define detailed ASO product decisions.
  • Define benefit structures, employer/group-level options, eligibility rules, exclusions, exceptions, and customization requirements.
  • Establish what is standard, configurable, employer-selectable, or requires approval/customization.
  • Define benefits including deductibles, copays, coinsurance, OOP maximums, accumulators, benefit limits, network tiers, and medical/Rx integration.
  • Translate product and benefit decisions into detailed business rules, configuration requirements, use cases, and acceptance criteria.
  • Identify impacts and dependencies across claims, eligibility, pharmacy, network, clinical programs, billing, reporting, and vendors.
  • Work closely with technology and configuration teams to ensure requirements are detailed enough for implementation.
  • Maintain decision logs, requirements traceability, open issues, dependencies, and configuration documentation.
  • Facilitate cross-functional requirements and design workshops and proactively identify missing business decisions.
Required Qualifications
  • 8 -15+ years of commercial health plan/payer experience.
  • Strong hands-on experience with ASO/self-funded health plan products.
  • Deep understanding of commercial medical benefit design and administration.
  • Experience translating benefit designs into claims configuration specifications or detailed functional requirements.
  • Strong knowledge of deductibles, copays, coinsurance, OOP maximums, accumulators, exclusions, benefit limits, and network-tier logic.
  • Experience with payer/core administration platforms such as Facets, QNXT, HealthRules, or similar.
  • Experience with employer-group customization and benefits configuration.
  • Strong understanding of Claims, Benefits, Eligibility, Network, Pharmacy, Clinical, Billing, and Reporting processes.
  • Excellent requirements documentation, analytical, and stakeholder-management skills.
 
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 10202573
  • Position Id: 9093700
  • Posted 12 hours ago

Company Info

About Palni Inc

At Palni, our ambition is matched only by our authenticity. We rely on teamwork to achieve our goals, with a laser focus on surpassing our customers’ expectations. Through collaborative efforts, we ignite innovation and drive growth, crafting solutions that elevate experiences and streamline efficiencies.

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SG

Samson Gangaram

Recruiter @ Palni Inc
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