Benefit Contract Specialist
Who we are
Harvard Pilgrim is a not-for-profit health plan and a full-service benefits company serving members in Massachusetts, New Hampshire, Maine and beyond. We make health care work better. We recognize diversity's impact and importance for our workforce, customers and providers, and through our contributions to the communities we serve. It's part of the way we do business.
What we value
Harvard Pilgrim believes that greatness is built from the inside out. It's created by individuals who share common goals, and who support and rely on one another to achieve them. Our core values guide us in how we treat, respond to and interact with our customers, business partners and one another.
Who we hire
We hire the best and brightest-talented individuals who value innovation, creativity and communication in the workplace. Harvard Pilgrim believes that by attracting, retaining and engaging diversetalent, we gain a sustained competitive advantage for continued growth.
Our employees bring Harvard Pilgrim's mission, values and brand to life in an inclusive and supportive environment where they are respected and valued for their contributions. Being part of the Harvard Pilgrim team means that you excel at what you do. You're dedicated to your work and continually look for new ways to serve your customers better.
What we offer
We do our best to support our employees in making the most of their lives both inside and outside of work. At Harvard Pilgrim, we know that a talented, engaged and inclusive workforce is our greatest strength. We have an excellent benefit package and are "T" accessible.Some of our benefits include:
* A comprehensive work and life benefits program, including medical and dental benefits, time away from work, retirement, financial protection and on-site fitness centers.
* Opportunities to learn and grow, build relationships, share your opinions and do what you do best every day.
* Ways to serve and give back to the communities where you live, work and play - through grants, fundraising and volunteering.
JOB SUMMARY:
Reporting to the Manager, Benefits Administration, the Benefit Contracts Specialist II is primarily responsible for the design, development and maintenance of benefit filing documents (handbooks, SOB range filings, RX brochures and any other Riders documents) that effectively communicate to the member the intent of the benefit design and also safeguards the company from legal exposure or liability. The Benefit Contract Specialist II will represent the Benefit Administration department in a variety of roles as determined by the department manager.
ESSENTIAL FUNCTIONS
- Participates on product development teams.
- Evaluates plan designs for operational feasibility and market competitiveness.
- Design new benefit packages.
- Write new benefit language for handbooks, SOB range filings, and Rx Brochures.
- Edit existing benefit documentation language to comply with changes in product design or amendments.
- Facilitate documentation reviews.
- Work with HPHCs corporate attorneys to obtain legal advice or conduct research regarding inquiries both internally and externally. Respond to these inquiries both verbally and in writing and then document the legal opinion, creating a reference for future inquiries.
- Assumes all project responsibility for the Plan Finder submissions including:
- Managing a calendar of plan finder dates
- Downloading and distributing templates
- Gathering and disseminating information from the federal government to impacted business areas
- Working with SMEs from other departments to ensure that timelines are met
- Successfully uploading HPHCs plan finder submissions on the federal government portals (HIOS and RBIS)
- Serving as subject matter expert for Plan Finder.
- Using project management methodology manage benefit/ product related projects as assigned
- Assure all work meets both internal and external compliance rules
- Serve as SME on benefit compliance rules
- Actively review upcoming changes in laws related to benefits
- Identify potential compliance issues in benefits designs
- Ensure benefit plan language is consistence with compliance standards
- Ensure benefit variations are in compliance with filings
- Identify, interpret and communicate state and federal benefit, licensure, and eligibility regulations and mandates as they apply to specific products, and in conjunction with other departments, identify and communicate same to the administration and operational systems areas at HPHC to ensure compliance.
- Serves a product subject matter expert for benefit accumulators and serves as team lead for operational team that researches and resolves accumulator related issues.
- Provide timely and accurate responses to benefit inquiries
- Research issues and facilitate resolutions
REQUIREMENTS
- Minimum of 5-7 years of professional experience in contract analysis and drafting or product development and management.
- Bachelors Degree in health science, business or related field is required.
- Knowledge of insurance contracts, health insurance or managed care products, HMO or health insurance benefit design and underwriting principles applied to health care.
- Outstanding knowledge of policies and procedures.
- Strong Project Management experience.
- Excellent understanding and working knowledge of benefits, policies and state regulatory compliance requirements.
- Excellent work and time management skills.
- Great attention to detail. Excellent research skills.
- Excellent communication skills, both verbal and written.
- Strong leadership, facilitation and creative problem solving skills.
- Ability to work effectively in a fast paced working environment.
- Demonstrated ability to resolve problems in a timely manner. Strong leadership, planning and analytical skills.
- Ability to effectively multitask in a fast paced changing environment