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

Palni Inc

Remote • Today

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Contract, Third Party

Depends on Experience

Palni Inc

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 14 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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Contact the job poster

Samson Gangaram

Recruiter @ Palni Inc

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Role: Health Plan ASO Product Configuration & Benefits SME Location: USA (Remote) Duration: 6+ months 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 produc

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Contract

Depends on Experience

Application developer - (Google Cloud Platform/Big Query)(Healthcare)- Remote - 6 Months

Remote

•

Yesterday

Application Developer Google Cloud Platform / BigQueryLocation: Fully Remote Anywhere in the U.S. Contract: Long-Term Contract Schedule: MondayFriday, 8:00 AM 5:00 PM Industry: Healthcare / PBMJob SummaryWe are looking for an experienced Application Developer with strong Google Cloud Platform, BigQuery, and SQL skills to support healthcare and pharmacy benefit analytics initiatives. The role involves working with large datasets, developing SQL/BigQuery solutions, performing data validation, a

Easy Apply

Third Party, Contract

Depends on Experience

Palni Inc

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

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.

Dice Id: 10202573
Position Id: 9093700
Posted 14 hours ago

Company Info

About Palni Inc

Go to company profile

Fitment

Dice Job Match Score™

To see how well you match this job, please log in or create an account.

Once logged in, be sure to complete your profile to get the most accurate match score.

Contact the job poster

Samson Gangaram

Recruiter @ Palni Inc

View Profile

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Remote

•

Today

Easy Apply

Contract

Depends on Experience

Application developer - (Google Cloud Platform/Big Query)(Healthcare)- Remote - 6 Months

Remote

•

Yesterday

Easy Apply

Third Party, Contract

Depends on Experience

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

Skills

Summary

Dice Job Match Score™

Samson Gangaram

Similar Jobs

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

Palni Inc

Job Details

Skills

Summary

Company Info

About Palni Inc

Dice Job Match Score™

Samson Gangaram

Similar Jobs