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Benefit Plan Builder (with RIMS System Experience)
Staff4MeMetro Manila, PH30+ days ago
Job type
- Quick Apply
Job descriptionAnalyze plan documents, amendments, policies, and mandates Recommend improvements for system-based adjudication Maintain records of active plan build tasks Document processing notes, exception codes, and upload finalized Manage benefit changes and test updates before finalizing Freeze / release updates in RIMS based on approvals Implement benefit changes per group policies and state regulations Respond to claims inquiries and troubleshoot system issues Manage mailbox and make necessary RIMS updates Conduct system testing and peer audits to ensure plan accuracy Communicate updates to departments (ID cards, billing, consultants) Coordinate with other plan builders and attend meetings Train internal teams on new or updated plans using documentation Work with IT to enhance RIMS functionality and share improvements Collaborate on provider contracts and automate processing Document and train others on unique arrangements Support reporting, special assignments, and tasks from management 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 Strong problem-solving and multitasking abilities Excellent written and verbal communication, especially technical 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 Professional and respectful team player
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
Documentation & Reporting
data
Renewals, Amendments & Rewrites
Compliance Monitoring
Claim Support
Plan Testing & Auditing
Collaboration & Communication
Training & Support
System Optimization
Special Projects & Provider Arrangements
Other Duties
Requirements
Technical & Industry Knowledge
Core Competencies
writing
pressure
Schedule : Monday to Friday, 8 : 00 AM – 6 : 00 PM E.S.T | 8PM-6AM PHT
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System • Metro Manila, PH
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