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Plan Builder, Insurance Services

Requisition ID
2025-46161
Category
Professional
Shift Type
Full-Time
Shift
8 Hour
Shift Schedule
Days
Facility
Community Medical Centers - Corporate Offices (CMC)
Location
US-CA-Fresno
Posted Date
6/11/2025
Min
USD $37.22/Hr.
Max
USD $48.39/Hr.

Overview

*All positions are located in Fresno/Clovis CA*

 

 

Opportunities for you!

  • Consecutively recognized as a top employer by Forbes
  • Vacation time starts building on Day 1, and builds with your seniority
  • 403(b) retirement plan with up to 8% matching contributions 
  • Free parking and electric charging
  • Great food options with on-demand ordering

 

Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.

 

We know that our ability to provide the highest level of care is through taking care of our incredible teams. Want to learn more? Click here.

Responsibilities

The Plan Builder is responsible for configuring and maintaining HMO, EPO, and PPO health plan designs within the CCH system. This role ensures accurate plan setup, compliance with regulatory requirements, and seamless integration with claims processing, eligibility, and billing functions. The Plan Builder collaborates with internal teams, clients, and vendors to implement and update benefit plans according to employer specifications.
 

 

Qualifications

Education
• Bachelor's Degree in Healthcare Administration, Business, Operations, or a related field required
 
Experience
• 3 years of experience in benefit plan configuration, healthcare claims processing, or related health plan operations required
• Experience with Electronic Data Interchange (EDI) transactions (e.g., 837, 835, 270/271, etc.) preferred
• Familiarity with SQL or other database query languages for plan validation preferred
• Prior experience in a TPA, insurance carrier, or benefits administration firm preferred

Disclaimers

• Pay ranges listed are an estimate and subject to change.
• If any bonuses are noted, they are only applicable to external hires meeting criteria.

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