Information Technology For Development Jobs in Draper

Health Plan Coding Contractor (Dental & Vision Experience Preferred)

Role Type: Contract

Experience Level: 2 - 3 year minimum preferred

Work Arrangement: Remote eligible (certain time zones preferred)

Hourly Rate Range - $30 / hour - $34/hour

Overview

We are seeking two Health Plan Coding Contractors to support backend medical benefit configuration and coding for health plan implementations. One of the roles requires specific experience in dental and vision coding.

These contractors will work closely with internal operations teams and implementation stakeholders to build, configure, and maintain accurate benefit structures within a health plan platform. The work involves handling protected health information (PHI), reviewing plan documents, and translating benefit details into coded system configurations.

Candidates should be comfortable working in a collaborative environment with operational leaders while also managing technical coding responsibilities independently.

Key Responsibilities

Health Plan Coding & Configuration

• Perform backend medical benefit coding and configuration within the claims adjudication system.
• Translate complex plan documentation such as Summary Plan Descriptions (SPDs) and Evidence of Coverage (EOC) into accurate system configurations.
• Support the build and implementation of member benefits based on plan documentation and contractual agreements.
• Work with internal teams to ensure coded benefits align with operational and compliance requirements.

Quality Assurance & Compliance

• Conduct validation and quality checks to ensure coding accuracy, consistency, and compliance with applicable regulations.
• Perform audits on coded benefits to ensure correct implementation across systems.
• Identify and resolve edge cases or complex benefit scenarios affecting claim processing.

Cross-Functional Collaboration

• Partner with internal operational managers on backend initiatives and process improvements.
• Work closely with implementation and launch teams responsible for onboarding new health plans and coordinating with insurance partners.
• Collaborate with operations teams to support benefit updates, claim processing accuracy, and issue resolution.

Process & Workflow Support

• Assist with workflow processes related to benefit configuration changes, including:
• Creating system rules to pause impacted claims when updates are required
• Conducting manual review to ensure proper claim adjudication
• Monitoring results before releasing claims back into automated processing

Required Qualifications

• Minimum 2years - 3 year of experience in medical coding, health plan coding, or benefit configuration.
• Experience working with health plan benefit structures or claims systems.
• Dental and vision coding experience required for one role.
• Familiarity with payer or third-party administrator (TPA) environments is preferred.
• Strong attention to detail and ability to interpret complex plan documentation.
• Ability to manage tasks independently while collaborating with cross-functional teams.

Preferred Qualifications

• Experience working with enterprise benefit platforms such as Facets, QNXT, HealthRules, or similar systems.
• Knowledge of healthcare regulatory frameworks affecting benefit design and claims processing.
• Prior experience supporting health plan implementations or benefit builds.

Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.