Account Installation Representative

About the role : The Account Installation Representative is responsible for accurately configuring and maintaining medical benefit plans within internal and TPA systems. This role ensures that members, providers, and clients have correct and up-to-date information on eligibility, coverage rules, authorization requirements, and claim adjudication parameters Key Responsibilities: Analyze product documents and policy schedules to build and configure benefit plans for both internal use and TPA. Set up eligibility, copays, deductibles, out-of-pocket maximums, covered services, and provider networks, Annual/lifetime caps and service-level exclusions/inclusion. Maintain and validate API/data feed integration between internal system and TPA systems (e.g., policy enrollment, benefit tables, provider networks). Review and validate group setup and benefit plan changes, updates, and renewals. Coordinate with underwriting, sales, and client services teams to gather accurate plan information. Validate benefit configurations before policy activation to avoid claim errors. Work closely with underwriting, sales, Business support, and policy validation teams to ensure accurate reflection of client and product specifications. Participate in UAT (User Acceptance Testing) for plan benefit setups or system enhancements. Coordinate with TPAs to align benefit configuration between internal system and the TPA platforms. Conduct benefit mapping and data exchange configuration manuals and documents with TPAs Maintain configuration documentation, setup logs, and audit trails as per regulator and internal compliance protocols. Responsible for partnering with broader Operations teams to ensure activities related to Operational Readiness, including business support, eligibility, compliance contact center and claims are ready to service by client s effective date. Responsible to resolve benefit-related discrepancies flagged by claims or customer service between internal system and the TPA platforms.

Qualifications: Bachelor s degree in healthcare administration, Business, or related field (or equivalent work experience) 1 - 2 years of experience in benefit setup or insurance policy administration within a health insurance company. Experience with benefit configuration tools and administrative platforms Familiarity with medical coverages and exclusions, policy wording, and product structure. Knowledge of insurance regulatory requirements (CHI, IA, Nphies.) Skills: Knowledge of regulatory standards benefits and products Excellent attention to detail and analytical skills Proficient in MS Office (Excel, Word) and data entry systems Strong understanding of benefit structures in SME and corporate policies. Experience working with TPA platforms and insurance core systems