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Benefits Specialist

Eingestellt von Enclipse Corp.

Gesuchte Skills: Sales, Marketing, Design

Projektbeschreibung

POSITION TITLE: Benefits Specialist

Purpose:
The Benefits Specialist supports the Sr. Manager, Benefit Administration in the development of benefit documentation, administrative processes and other relevant materials. Participates in cross-functional efforts related to the clarification, interpretation, and documentation of benefit administration processes and medical policy development. Partnerships with Medical Group and Health Plan representatives to ensure consistent interpretation of benefit rules and policies. Serves as a liaison with the legal department to clarify and document benefit or contractual language and interpretations. Contributes to the management and maintenance of documentation used to communicate with regulators or regulatory bodies.
In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Service Quality Credo, the Company Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.

Accountabilities: 
- Maintains current and in-depth knowledge of how benefits are and can be administered throughout the various  systems and departments. Serves as a point of contact to facilitate the resolution of escalated benefit-related inquiries from across the Mid-Atlantic region.
- Responds to customized product documentation requests by Sr. Manager, Benefit Administration for product managers, sales representatives, account managers, and other marketing, sales, and business development team members.
- Supports the development of training materials and the delivery of training sessions for key stakeholders throughout the organization to communicate benefit clarifications, interpretations, and decisions.
- Provides revisions to current products, and relevant changes in internal systems, regulatory requirements, and benefit administration policy and procedure changes.
- Maintains database of all benefit packages offered as well as an exception tracking system. Develops process of tracking benefits no longer offered. Develops and produces reports that will aid in creating a Quality process for benefit design and offerings.
- Ensures that all benefit designs are accurately documented in sufficient detail so as to be entered into systems, allow for smooth administration and provide clarity to members and internal stakeholders
- Participates and supports Medical Benefit Policy Committee meetings and Benefit Policy and Administration Committee (BPAC) meetings with documentation on research or assessment of industry standards, Medicare guideline or other relevant materials for rendering decisions on medical policies or benefits.
- Ensures that all benefit designs and interpretations are accurately documented in sufficient detail so as to be entered into systems, for smooth administration and clarity to users.
- Serves as a resource for resolution of benefit and contractual clarification issues. Familiar with ICD 9, CPT and other benefit classification/coding tools to ensure appropriate medical definition and benefit rules. 
- Attends product and/or legal meetings as applicable to craft recommendations for benefit decisions.
- Ensures that all relevant stakeholders are included and communicated with when researching and resolving issues. Ensures that there is follow-up on implementation of recommendations.
- Presents reports, analyses and recommendations to all appropriate stakeholders. Designs metrics and reports to accurately reflect the work of the unit.
- Supports alignment of benefits with pricing tools and system configuration. Works with vendors and internal stakeholders to ensure accurate configuration/validation of benefit variables.
- Works closely with the Marketing, Pricing, and Contracts teams to drive benefit designs and strategies consistent with the overall Product Marketing and MSBD strategy. 
- Facilitates an environment that is customer service focused (both internally and externally).
- Participates in responding to RFP's.
- Performs other related duties as directed.

Minimum Requirement - Relevant Years of Experience:
- Three years of experience in managed care, HMO operations, or other area relevant to making new healthcare services within a membership environment required.
- Strong customer and market orientation, as well as broad knowledge of HMO products and healthcare operations required.
- Experience in adult education, innovative training methodology and evaluation techniques required.
- Excellent written and oral communications skills required.
- Working knowledge of Federal HMO Laws OPM/FEHB Regulations; Maryland & Virginia HMO Laws Federal TEFRA, COBRA, and Medicare Laws and Maryland COBRA Laws & Regulations is required.
- Exhibits an ability to focus on details and proactively recognize potential benefit administration and product documentation issues before they occur required.
- Demonstrated strong organizational, operational, problem solving, organizational, planning, communication and interpersonal skills required.
- Demonstrated ability to work independently with limited supervision as well as the ability to work in a team environment required.
- Health care, benefits, and/or insurance experience preferred.
- Bachelor's Degree or advancde degree in business, healthcare related fields is required.

Projektdetails

  • Vertragsart:

    Contract

  • Berufserfahrung:

    Keine Angabe

Geforderte Qualifikationen

Enclipse Corp.