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.
Responsibilities
Plan 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
data
Renewals, 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
Requirements
Technical & 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