Implementation Specialist (164) Irvine, California

Implementation Specialist
Your mission, as an Implementation Specialist will be to effectively and accurately gather clients plan design and data reporting needs to ensure a successful implementation.
Reports To: Manager of Systems Implementation
Project Management & Configuration Skill Sets: 
  1. Analyze all Health & Welfare plan eligibility information and benefit calculation rules.
  2. Document all plan eligibility, plan dependency, rules, etc.
  3. Use online vendors’ configuration tool to build system.
  4. Maintain system throughout plan year by making any needed adjustments due to acquisition, downsizing, plan termination, etc.
  5. Research any related issues relative to system performance and/or system calculations.
  6. Coordinate milestone timelines with vendor (i.e., resourcing, site build, testing, open enrollment, closeout, etc.)
  7. Work overflow of internal research requests and/or EDI transmissions
  8. Perform all testing with new/updated connectivity requirements.
  9. Coordinates client kick off meetings and Project Manages the implementation of site based upon agreed timeline.
  10. Responsible for coordination and collaboration of data management functions and communicates specifications to client.
  11. Assist in analyzing client data requirements and goals to obtain all applicable data elements to support system and meet client goals.
Data Skill Sets:
  1. Assist in analyzing client data requirements.
  2. Identify and perform data validation process of client data and online vendor data.
  3. Work with carriers and client to obtain file specifications for EDI.
  4. Perform all testing with new/updated connectivity requirements.
  5. Send and maintain scheduled EDI transmissions to carrier and clients.
  6. Maintain client and carrier relationships at interface level.
  7. Load election information and build self-service reports for billing & reconciliation.
  8. Balance workload of Data Management Analysts for inbound and outbound files of the department.
  9. Responsible for auditing and quality control process of all EDI transmissions.
  10. Maintain and report monthly metrics of file transmissions and data validation process.
Minimum Qualifications:
  • High school diploma required;
  • AA / Bachelors degree in a related field preferred
  • Candidates must have a verifiable background in plan design and calculations, H&W plan administration, insurance industry (carriers) or TPA field
  • Candidates must have a minimum 6 months customer service experience
  • Candidates must have experience building or using online enrollment systems
  • Candidates must understand data specifications and requirements for reporting needs

Specific Abilities:

  • Ability to type minimum 40 WPM
  • Customer service skills;
  • Listening skills;
  • Logical and analytical skills;
  • Answers courtesy;
  • Ability to focus and actively participate on client calls;
  • Identify issue;
  • Solution Engineer;
  • Clarify customer issues;
  • Excellent attendance & punctuality
  • Is expressive, enthusiastic and alert;

Specific Skills:

  • Ability to use standard office equipment such as printer, copier, scanner
  • Ability to communicate clearly verbally & in writing using proper grammar
  • Strong problem solving skills
  • Ability to research issues using multiple data sources

Specialized Knowledge, Licenses:

  • Strong customer service skills
  • Intermediate skills level of MS Office applications and web based eligibility systems
Success Factors
  • Ability to adjust to changing environment
  • Positive attitude
  •  Time management
  •  Comfortable asking questions
  • Perform detail oriented work
  • Take initiative
  • Team player