Responsible for the contractual documents for their assigned product line(s), which include the more complex nat'l accounts, reg'l strategic accounts, Fed Employees Health Benefits Plan & Sr Advantage (Medicare) plans. Generates product specific & group specific iterations of standard & nonstandard contractual documents for filing w/ state regulatory agencies &/or delivery to group/consultant customers. Provides quality assurance review for analyst checklists and/or product standards & SERFF packaging prepared by the Coord I to ensure that filed contractual documents comply w/ state law. Contractual documents include the Group Agreement, Evidence of Coverage, Benefit Summaries, riders, applications, & other documents which require filing w/ & obtaining approval from state regulatory agencies &/or approval by group/consultant customers, to enable the marketing & sale of Company insurance products. Responsible for working collaboratively w/ multiple internal & external customers to assess & coordinate revisions to contractual documents. This involves researching business practices, seeking legal & regulatory reviews of concepts, packaging info for technical writer, & soliciting approvals.
Essential Functions:
- Provide subject matter expertise for contractual matters related to local & nat'l custom negotiated large groups, including FEHBP & Sr Advantage Medicare product line
- Represent NW on nat'l work groups & communities of practice for RFP/renewal cycle & issues arising from contract development & negotiations relative to custom negotiated accounts
- Analyze custom negotiated contracts for compliance w/ state law
- Summarize significant contract changes for large group contract proposals to support the timely completion & submission of RFP/renewal responses
- Customize & populate templates w/ group specific and/or product specific benefit data variables to reflect contract provisions
- Assign & track approp form numbers for contractual documents
- Conduct peer review/quality assurance for other team members
- Revise contractual documents in response to regulator comments for submission to state regulators & facilitate internal approvals of revised text
- Create, or review approve SERFF filings created by Coordinator I for submission to state regulators
- Conduct SERFF quality control audits for other team members
- Develop & maintain project plans for filing contractual documents to meet critical deadlines (as set out in Master Calendar, group customer SOW/MOU or RFP schedule), engaging approp work group members at a local & nat'l level, documenting & communicating status, & ensuring deliverables are met
- Participate in Master Calendar process & update it for assigned product lines
- Organize all filing documentation, decisions, resource materials for easy retrieval by self & other team members
- Develop subject matter expertise for assigned benefits and/or product lines
- Represent Contract Administration when working w/ other depts & work groups to address issues related to assigned benefits and/or product lines & to understand proposed changes to product lines & benefits
- Review & edit marketing collateral & enrollment forms to ensure alignment w/ approp contractual documents
- Respond to requests w/in timelines in SLA
- Maintain desk top manual for all functions performed w/in this position & for the dept
- Perform other contracts related duties as assigned by manager to support the team environment
- This job description is not all encompassing
Qualifications:
Basic Qualifications:
- Three (3) years of experience in the health or life insurance ensuring that contracts are in compliance with state and federal regulatory requirements
- One (1) year of experience creating and submitting electronic filings via SERFF
- Bachelor's degree in related field or equivalent work experience
- Basic knowledge of federal and state (Oregon and Washington) laws and regulations affecting HCSCs or other types of health insurance
- Working knowledge of the technical construction of contracts or other legal or technical manual types of documents
- Project management and exceptional prioritization, time management, and organizational skills
- Demonstrated ability to summarize complex information for a variety of audiences
- Excellent oral and written communication skills
- Demonstrated problem solving and critical thinking skills and ability to make recommendations
- Comfort in a self-taught, self-directed environment
- Ability to work collaboratively with professionalism with all levels of staff in multiple departments
- Ability to work well under pressure and focus on details consistently in a deadline-driven environment
- Ability to work successfully with standardized work flow processes to enhance efficiency and quality
- Proficient use of standard Microsoft Office software, including advanced functions in MS Word (styles, sections, formatting, footers, track changes, table of contents, compare documents)
- Strong interpersonal and communications skills (1:1, peer, team, presentations, written)
Preferred Qualifications:
- Four (4) or more years of experience in project management or consulting or related experience managing multiple workstreams, preferred
- Five (5) or more years of experience in the health care industry drafting and editing contractual documents, preferred
- One (1) or more years of experience with Medicare Advantage health plans, preferred
- One (1) or more years of experience with a document management system, preferred
- Bachelor's degree in health care, public administration, business administration, or other related field, preferred
- Knowledge of KP contracts, benefits, policies and procedures, preferred
- Advanced knowledge of federal and state laws and regulations affecting HCSCs, preferred
- Knowledge of Medicare Advantage health plans, preferred
- Understanding of OPM/FEHBP contracting and annual change processes, preferred
- Understanding of medical and/or dental terminology, preferred
- Understanding of health insurance benefits administration and/or underwriting concepts, preferred
- Advanced expertise with standard Microsoft Office suite (including databases) and mainframe or custom-built computer programs and ability to learn new systems with minimal formal training, preferred
- Ability to understand and apply laws and regulations related to health care service contractors to contractual documents, preferred
- Ability to research and assess contractual issues in a regulated industry, exercising judgment as to when to escalate issues, preferred
- Ability to conduct, interpret and present qualitative analysis, preferred
- Excellent oral communication skills in a teleconference working environment, preferred
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.