Matthew Skeels
Seguin
Summary
Renewals | Complex Plan Configuration | Claims Systems (GBAS, VBA)
Self-funded benefits operations professional with 14 years in healthcare administration and 8+ years in TPA plan configuration and renewal execution. Managed approximately 150 annual renewals and 25 new implementations for mid-market and large employer groups (150–4,000+ lives), including professional sports organizations. Experienced in complex multi-structure plan builds, front-end and claims adjudication configuration, accumulator validation, UVR builds, and renewal-driven benefit restructuring. Seeking a structured, process-driven organization with defined QA standards and merit-based growth.
Overview
13
13
years of professional experience
Work History
Plan Builder & Benefit Analyst
Kempton Group Administrators
Oklahoma City
06.2024 - Current
- Configure and maintain self-funded medical, dental, and vision benefit plans within VBA claims adjudication and front-end systems.
- Build and validate claims processing logic including deductibles, copays, coinsurance, accumulator structures, and benefit overrides.
- Perform test claim audits and accumulator reviews to identify and resolve configuration discrepancies prior to production release.
- Configure benefit structures across ancillary platforms including IVR and member portal systems.
- Produce compliant plan documentation including SPD, SBC, and Schedule of Benefits.
- Resolve cross-department escalations related to claims adjudication and plan configuration accuracy.
Implementation Specialist – Implementation Team
Imagine360
San Antonio
06.2022 - 02.2024
- Managed approximately 150 annual renewals and 25 new client implementations during high-volume Q4 cycles.
- Configured complex self-funded medical, dental, and vision plans for mid-market and large employer groups (150–4,000+ lives).
- Built embedded and aggregate deductible structures across PPO, RBP, cost-plus, OOA, indemnity, MEC, and tiered network designs.
- Configured front-end benefit structures in GBAS for provider, member, and customer service platforms.
- Built UVR configurations and generated compliant SBC, SPD, and schedule documentation.
- Executed renewal-driven benefit restructuring including deductible resets, network modifications, and effective date transitions.
- Served as escalation point for configuration discrepancies between internal departments and external stakeholders.
- Participated in direct contract and non-standard plan builds within multi-vendor arrangements.
Benefits Specialist
Imagine360
San Antonio
09.2016 - 06.2022
- Developed and maintained federally regulated Summary of Benefits and Coverage documentation.
- Coordinated documentation with claims configuration teams to ensure alignment between member-facing materials and adjudication logic.
- Resolved high-volume internal benefit interpretation and compliance discrepancies.
Customer Service Representative
UnitedHealth Group
San Antonio
03.2013 - 09.2016
- Assisted members with claims navigation and benefit interpretation across medical, dental, and vision plans.
- Conducted internal audits to ensure proper client and group affiliation compliance.
- Identified and reported documentation discrepancies impacting member coverage.
Skills
- Self-Funded Plan Configuration,
- Renewal & Implementation Management,
- Mid-Market & Large Employer Plans,
- Complex Plan Structures (Embedded, Aggregate, PPO, RBP, Cost-Plus, OOA, MEC),
- Accumulator & Deductible Validation,
- Claims Adjudication Systems (GBAS, VBA), Front-End & UVR Configuration,
- Provider Network Management
- Test Claim Auditing,
- Regulatory Documentation (SBC, SPD),
- Cross-Department Escalation Resolution
Timeline
Plan Builder & Benefit Analyst
Kempton Group Administrators
06.2024 - Current
Implementation Specialist – Implementation Team
Imagine360
06.2022 - 02.2024
Benefits Specialist
Imagine360
09.2016 - 06.2022
Customer Service Representative
UnitedHealth Group
03.2013 - 09.2016