Benefit Contracts AnalystPortland, OR
The Benefit Contract Analyst is accountable for the development of Member enrollment materials (including, but not limited to, booklets, contracts and Summary of Benefit Changes (SBCs). Coordinates the filing of regulatory documents with the insurance division. Analyzes insurance division objections and organizes responses and resubmission functions.
- Research, draft, produce and file collateral for use by operations support, marketing, and sales divisions
- Regulatory filing and maintenance to ensure that all required product documents comply with federal and state laws including state insurance code requirements, prior to submission with the Insurance Department and serve as a resource to other divisions.
- Negotiate and coordinate with internal, as well as external business partners to develop, write, revise, file (as required), and coordinate the production of contracts, certificates of coverage, for all lines of business (large/small group, individual and self-funded plans).
- Interpret contract provisions and ensure proper retention of complete clients' files.
- Development and support of on-line communications regarding contract contents for use by other divisions in the administration and support of product packages.
- Investigate and respond to requests for interpretation of contracts/booklets and plan
- documents/summary plan descriptions and follow-through to ensure proper administration of such documents is being performed by all applicable divisions.
- Cultivate and maintain relationships with key internal (cross-divisional) and external (agents, groups and Insurance Department) contacts.
- Establish and maintain an effective working relationship with the Insurance Department to facilitate regulatory compliant form filings.
- Access and navigate the electronic publishing system used for creation of member
- contracts/booklets/plan documents/summary plan descriptions.
- Work continuously with other divisions to evaluate and support the development of new products and/or modification of existing products to remain competitive with current business and market needs and allow for continuous efficient service to be provided to all internal and external clients.
Normally to be proficient in the competencies listed above
- Must possess strong organizational skills with a demonstrated ability to prioritize, coordinate and implement multiple projects within varied or simultaneous time constraints.
- Ability to coordinate activities with all levels of staff within the Plan and external agencies through clear and concise verbal and written communication skills, including tactful and persuasive negotiation skills.
- Ability to work independently and exercise sound judgment while developing solid working relationships with internal and external business partners, including, but not limited to, Sales, Sales Operations, Product and the Insurance Division.
- Ability to comprehend, master and draft all aspects of the Plan's contracts/booklets, benefits administration, and overall business processes for all lines of business/products including group specific or custom groups.
- Demonstrated technical skills necessary to effectively navigate the electronic publishing system used for document creation.
- Ability to work in high-pressure circumstances on multiple concurrent projects involving multidisciplinary, unconnected tasks, and proven ability to initiate and independently produce detailed and highly accurate work.
- Knowledge of the health insurance industry, including benefit design and compliance issues with capability of incorporating into contracts and other related materials.
- Experience/understanding and knowledge of federal laws and guidelines (including but not limited to COBRA, HIPAA, ERISA, USERRA, DOL. etc.) and applicable state insurance code and regulations, including the Affordable Care Act (ACA).
The Benefit Contracts Analyst would have a Bachelor's Degree in Healthcare, English, business or health care administration, communications and 3 years work-related experience or equivalent combination of education and experience.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com