- Drafts group and individual, indemnity and HMO, contracts and certificates for risk and self-insured accounts. Files all forms with the respective Insurance Administrations and regulatory agencies as appropriate also to ensure legal compliance of forms as known.
- Responds to Insurance Administration inquiries; completes Insurance Administration surveys as needed and assigned. Responds to Central Appeals Unit, Executive Inquiry, Corporate Audit and other department inquiries that are of an elevated status. Consults with the Legal Staff, Government Affairs and other departments as necessary. Research appropriate local and federal code and regulations. Produces all production forms; writes and maintains implementation documentation and provides detailed implementation instructions.
- Audits Contracts and other special documents to ensure accuracy and resolves issues with necessary departments. Participates/leads in Company initiative implementation and Operations meetings and other meetings that affect contracts and certificates such as the Legislative Review Committee and Team Implementation Meetings; participates in the implementation of other Company initiatives and projects. Audits Account Installation master documents and procedures for compliance.
- Monitors performance of contracts for conformance to contractual terms and conditions and ensures that contracts are in accordance with legal requirements, customer specifications, laws, and regulations. Interprets benefit issues, provides contract interpretations; resolves complex issues and benefit interpretations with the Legal staff, Health Care Policy, etc. as necessary.
- Reviews, interprets and responds to account specific RFPs, RFIs, and other requests (nonstandard type) and writes and files with regulators, group account specific contracts and certificate language as needed. Produces and implements account specific production forms for customized benefits.
- Reviews Corporate Communications promotional literature, internal documents, ecommerce documents and training materials to ensure contract integrity. Analyzes proposed product designs and changes to product designs and provides input to the work groups and Marketing and Product Development that define same.
- Knowledge of contracting strategies or willingness to learn.
- Ability to provide contract compliant solutions with partners and functional teams.
- Proficient in Microsoft Office applications.
- Excellent communication skills both written and verbal.
- Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
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Senior Contract Specialist - Baltimore, United States - Blue Cross and Blue Shield Association
Description
Resp & QualificationsPURPOSE:
Senior Contract Specialist works closely with Corporate Governance (Legal), Government Affairs, Product, Marketing, Mandates, Health Services, and Strategy and Transformation providing input to company, divisional and departmental goals and initiatives, to ensure contract form compliance, recommend and implement improvements.
This position supports Benefit Contract Management (BCM) by performing accountabilities/tasks that include but are not limited to: analyzing proposed changes to contract forms and templates; recommending filing strategies; drafting/revising contract language; reviewing contract forms, templates and related marketing materials; reviewing and tracking mandates; preparing and submitting electronic filings via SERFF; tracking status of filings; attending and representing BCM at strategy and work group meetings; and contributing to BCM strategies and process improvements.
ESSENTIAL FUNCTIONS:
QUALIFICATIONS:
Education Level:
Bachelor's Degree OR In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years' experience in health insurance benefit/product knowledge, benefits delivery systems or contract managementPreferred Qualifications
Juris Doctorate (J.D.), with four 4+ years extensive writing experience; Attorney; degree in Law, Health Care Administration, or related field; Paralegal.
Salary Range:
$62,064 - $123,266
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed.
This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration.
It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.
In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
DepartmentBenefit Contract Management
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.
It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To ApplyPlease visit our website to apply:
Federal Disc/Physical Demand
Note:
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship.
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