Must have 5+ years of contract management experience.
Must have recent healthcare contract management experience.
This role will involve reviewing contracts and making edits as well as comparing multiple contracts.
Must have solid communication and writing skills.
Will be reviewing contracts related to evidence of coverage.
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: 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. Researches 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.
ESSENTIAL FUNCTIONS
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.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: Bachelor's Degree
Experience: 5 years experience in health insurance benefit/product knowledge, benefits delivery systems
or contract management
In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
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