benefit plan b uilder (with rims system experience)Staff4Me

We are seeking a highly skilled and detail-oriented Benefit Plan Builder to configure and maintain client benefit plans using the RIMS processing system. This role is critical to ensure accurate and automated claims adjudication. As a "super user" of RIMS, you'll collaborate with management and IT, troubleshoot processing issues, test software releases, and support special projects tailored to client needs.ResponsibilitiesPlan Setup & Administration
Build new group and product plans in RIMS, including run-in plans
Use internal tools and checklists to ensure accurate configuration
Plan Design Review
Analyze plan documents, amendments, policies, and mandates
Recommend improvements for system-based adjudication
Documentation & Reporting
Maintain records of active plan build tasks
Document processing notes, exception codes, and upload finalized
dataRenewals, Amendments & Rewrites
Manage benefit changes and test updates before finalizing
Freeze/release updates in RIMS based on approvals
Compliance Monitoring
Implement benefit changes per group policies and state regulations
Claim Support
Respond to claims inquiries and troubleshoot system issues
Manage mailbox and make necessary RIMS updates
Plan Testing & Auditing
Conduct system testing and peer audits to ensure plan accuracy
Collaboration & Communication
Communicate updates to departments (ID cards, billing, consultants)
Coordinate with other plan builders and attend meetings
Training & Support
Train internal teams on new or updated plans using documentation
System Optimization
Work with IT to enhance RIMS functionality and share improvements
Special Projects & Provider Arrangements
Collaborate on provider contracts and automate processing
Document and train others on unique arrangements
Other Duties
Support reporting, special assignments, and tasks from management
RequirementsTechnical & Industry Knowledge
Experience with QicLink or VBA platforms
2-3 years of RIMS system experience
1-2 years of plan building experience
4-6 years of high-level claims processing and benefit knowledge
Reinsurance and contract knowledge (specific & aggregate)
Familiarity with federal laws affecting self-funding
Medical terminology and coding proficiency
Core Competencies
Strong problem-solving and multitasking abilities
Excellent written and verbal communication, especially technical
writing
Mathematical proficiency and attention to detail
Ability to work independently and collaboratively
Reliable, punctual, flexible, and emotionally mature
Initiative-driven, with leadership potential and composure under
pressure
Professional and respectful team player
Schedule: Monday to Friday, 8:00 AM - 6:00 PM E.S.T | 8PM-6AM PHT
Staff4Me

Metro Manila
Permanent
Full-time