- Leads ongoing benefit activities including benefit development and current benefit monitoring.
- Audits and reviews complex benefit contracts and makes recommendations based on regulations and product/benefit design changes
- Works with Product Development, Customer Marketing, Sales, Actuarial, Marketing Communications, Business Intelligence, and other internal departments to implement, communicate and monitor all activity affecting benefits.
- Works with, and develops relationships with external associates (e.g., regulators, legislators, lobbyists, other insurers/health plans, trade associations, etc.).
- Leads other specialists on benefit design aspects of research, mandates and process to further their skills. Maintains team process documentation.
- Represents the department and division in cross-functional activities that impact department operations (i.e. governmental and regulatory changes).
- Analyzes interdepartmental procedures and their impact on benefit structure; makes recommendations for enhancements and increased efficiencies as appropriate.
- Oversees benefit change proposals and recommendations to ensure compliance with state and federal laws surrounding benefit coverage. Tracks, reviews and analyzes regulations which can impact benefit design and presents final regulations to Product Platform Team for final recommendations. Responds to inquiries from regulators regarding benefit design and compliance.
- Prepares and conducts benefit presentations and training to internal and external audiences.
- Oversees benefit coding configuration lists for Product Platform and process for new benefit design and ongoing code updates.
- Oversees benefit design summary information creation for internal hand-off to departments for development of marketing collateral, automated customer summaries and other customer facing materials. Oversees review of final materials for benefit accuracy sign-off.
- Analyzes trends and shifts in competitive benefit offerings and communicates competitive benefit design changes and strategic implications to internal management team to help drive product development process.
- Monitors regulator websites for updates related to benefit compliance and federal/state interpretations of mandates/rules.
- Responds to RFP/RFI proposals for large segments of business regarding benefit information or design.
- Acts as benefit expert across internal departments for ongoing benefit administration.
- Leads the Medicare benefit design bid submission process to CMS for Medicare PPO line of business. Also performs and leads competitive research, benefit analysis and review of marketing collateral for benefit accuracy.
- Performs and leads benefit analyses to compare benefit levels between products and assists in presentation for senior management review.
- Responds to inquiries regarding specific benefits, design, and modification as well as status information and general trouble-shooting to meet the needs of the business customer.
- Recommends improvements to department processes.
- Acts on behalf of the Manager during his or her absence.
- Conduct market research, data analysis, and benefit training.
- Demonstrated ability to organize and manage time to effectively prioritize the workload and adapt to shifting priorities.
- Demonstrated ability to think analytically, apply analytical techniques, obtain benefit information from a variety of internal and external sources and provide in-depth analysis and recommendations for corrective or performance enhancing benefit strategies.
- Experience in report preparation, project documentation, or policy and procedure writing, including the ability to organize and review statistical data and write concise relevant communications.
- Demonstrated ability to communicate effectively with all levels of management; with tact, orally and in writing. Demonstrated writing and editing skills. Strong presentation skills needed.
- Broad knowledge of the health insurance industry, including benefit design, market demands and compliance issues.
- Demonstrated ability to work effectively with all levels of staff throughout the organization.
- Demonstrated ability to lead employees in working effectively within a team atmosphere to achieve department goals and objectives and thrive in a fast-paced environment.
- Extensive knowledge of benefit regulations in the Cambia service area and federal level.
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Benefit Specialist II or III, DOE - Portland, United States - Cambia Health Solutions
Description
Benefit Specialist II or III, DOE
Remote opportunity for residents of Oregon, Washington, Idaho and Utah
Primary Job Purpose
The Benefit Development Specialist II utilizes knowledge of current and proposed healthcare regulations and potential benefit offerings to analyze, develop, implement and monitor new or existing benefits in order to ensure benefit offerings are compliant with state and federal regulations, competitive and efficient to administer.
General Functions and Outcomes
Minimum Requirements
Normally to be proficient in the competencies listed above
The Benefit Development Specialist II would have a Bachelor's degree in business, health care or related field and a minimum of five years' experience in benefit administration, project coordination, or the equivalent combination of education and experience.
The Benefit Development Specialist III would have a Bachelor's degree in business, health care or related field and seven years' experience in benefit administration, project coordination, or the equivalent combination of education and experience.
#LI-Remote
