Health Plan Compliance Specialist - United States - Relation Insurance Inc

    Relation Insurance Inc
    Relation Insurance Inc United States

    1 week ago

    Description
    WHO WE ARE
    Relation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.
    WHAT WE'RE LOOKING FOR
    The Health Plan Compliance Specialist is responsible for the creation, maintenance, and delivery of compliant health plan documentation for ERISA and non-ERISA health plans. The individual in this role ensures all plan materials meet federal and state regulatory requirements, while aligning with client benefit designs and organizational standards. The Specialist collaborates cross-functionally and participates in client implementation and renewal activities to support accurate and timely document production.
    A GLIMPSE INTO YOUR DAY
    • Creates, maintains, and updates PHIA-regulated Summary Plan Descriptions (SPDs) and Plan Documents for ERISA and non-ERISA health plans, ensuring compliance with all applicable regulations.
    • Produces Summaries of Benefits and Coverage (SBCs) in accordance with federal and state compliance requirements and ensure alignment with unique client plan design.
    • Manages plan renewals and drafts plan amendments, ensuring accuracy, consistency, and timely delivery across a high-volume document environment.
    • Supports the production and delivery of 80+ plan documents per month, adhering to established timelines and quality standards.
    • Participates in client implementation meetings to review benefit outlines, clarify plan requirements, and gather all necessary information prior to document creation.
    • Collaborates with cross-functional teams (e.g., implementation, compliance, operations) to ensure plan materials are aligned, compliant, and reflective of client expectations.
    • Collaborates with the member services team leads to ensure accurate information needed to allow that team to effectively respond to member inquiries and resolve benefit-related questions.
    • Serves as a liaison with Edison Health Solutions' compliance vendors to ensure regulatory updates, template changes, and mandated federal guidelines align with contracts, benefit designs, and are incorporated into all health plan materials.
    • Conducts quality reviews to confirm plan documents accurately reflect approved benefit designs and regulatory requirements.
    • Maintains organized documentation records and version control in accordance with internal procedures and compliance standards.
    • Assist with regulatory audits, client compliance inquiries and review related to the plan document.
    • Coordinate with vendors to support required federal and state health plan filings, including but not limited to Gag Clause Prohibition Compliance (GCPCA), RxDC reporting, NY HCRA reporting, and other regulatory compliance submissions applicable to self-funded health plans.
    • Conduct the preparation, validation and submission of data and documentation for mandated filings listed above.
    • Maintain compliance calendars, filing records and documentation needed to support audits, client inquiries and regulatory reviews.
    • Performs other projects, duties, and tasks, as assigned.
    WHAT SUCCESS LOOKS LIKE IN THIS ROLE
    • High School diploma or equivalent. Bachelor's degree in Business, Health Administration, Public Policy, English, or related field; equivalent experience preferred.
    • Strong writing, editing, and proofreading skills with attention to detail.
    • Strong knowledge of employee benefits and health plan concepts (medical, Rx, dental, vision, HSA/HRA/FSA).
    • Working knowledge of the laws and regulations associated with HIPAA.
    • Strong knowledge of health plan design & terminology.
    • Willingness to adhere to all principles of confidentiality.
    • Proficiency with Microsoft Word (templates/styles), Excel, and Adobe Acrobat.
    • Ability to manage multiple deadlines in a fast-paced, high-volume environment.
    • Ability to work independently and follow through on deliverables.
    • Excellent communication and collaboration skills.
    • Proficiency with Microsoft Office (Word styles/templates, Excel), Adobe Acrobat, and redlining tools.
    • 2+ years of experience working for a Third Party Administrator, health insurance broker, carrier, or benefits consulting firm in a role involving benefit plans, client implementation, compliance, or plan document preparation preferred.
    • Familiarity with plan document generation platforms or template libraries preferred.
    • Exposure to ERISA, ACA, HIPAA, COBRA, MHPAEA, and state benefit mandates preferred.
    • Familiarity with SBC templates and plan document generation platforms preferred.
    • A Life Accident and Health License from state of domicile is preferred.
    WHY CHOOSE RELATION?
    • Competitive pay.
    • A safe and healthy work environment provided by our robust benefit program including family health and wellness programs, 401K, employee assistance programs, paid time off, paid holidays and more.
    • Career advancement and development opportunities.
    Note: The above is not all encompassing of the full position description.
    Relation Insurance Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
    The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Relation, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is presented within this posting.

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