Plan Document Specialist

Position Location: 100% remote

Responsibilities

• Current Client Plan Documents
  • Drafts, restates, and amends Plan Documents (including summary plan descriptions, summaries of benefits and coverage, statement of material modification, and any other benefit summary) for medical, prescription, dental, vision, disability, executive plans, and all manner of consumer-driven health plans under Section 125, Section 132, and health reimbursement arrangements for existing clients.
  • Ensures Plan Documents are compliant with applicable state and federal laws and regulations, including ERISA, COBRA, PHSA, HIPAA, and applicable State insurance law.
  • Communicates extensively with clients/brokers verbally and in writing to expedite the amendment or restatement of Plan Documents and the printing thereof.
  • Coordinates with other EBMS departments and/or team members to expedite the implementation of new benefit structures for new and existing clients to meet established deadlines.
  • Identifies areas of inconsistency in the Plan Documents with federal and state laws and works with other EBMS team members to resolve and clarify the inconsistency.
  • Distributes and obtains appropriate signatures for new and amended Plan Documents to clients, brokers, EBMS team members, and Stop Loss Carriers.
  • Maintains electronic Plan Document Directory to ensure proper documents are available for internal use.
  • Distributes current Plan Documents to appropriate EBMS departments.
• New Client Plan Documents
  • Acts as a facilitator for the process to create Plan Documents by acting as a liaison between new clients, brokers, and assigned EBMS team members to create new Plan Documents that meet client and broker expectations.
  • Drafts Plan Documents (including summary plan descriptions, summaries of benefits and coverage, statement of material modification, and any other benefit summary) for medical, prescription, dental, vision, disability, executive plans, and all manner of consumer-driven health plans under Section 125, Section 132, and health reimbursement arrangements for new clients.
  • Communicates extensively with clients and brokers verbally and in writing to expedite the draft Plan Document and the printing thereof.
  • Remains current on applicable state and federal laws or regulations that affect all manner of benefit plans and applies knowledge of these laws to identify areas of risk and noncompliance within new client plans.
  • Identifies areas of inconsistency in new client plans with federal and state laws and works with other EBMS team members to identify solutions.
  • Remains current on Relius Document System.
  • Coordinates with other EBMS departments and/or team members to expedite the implementation of new benefit structures for new clients to meet established deadlines.
• Customer Service and Relationship Management
  • Organizes and hosts conference calls to determine and prioritize deadlines while escalating issues to the appropriate EBMS team members, clients, and brokers.
  • Acts as a role model in demonstrating core values in customer service delivery.
  • Provides timely and thorough follow-up with internal and external customers.
  • Appropriately escalates difficult issues up the chain of command.
• Quality Assurance
  • Serves on committees, work groups, and/or process improvement teams to assist in improving quality and customer satisfaction.
  • Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
  • Performs self-quality monitoring to develop and execute plans to meet established goals.
  • Provides ongoing feedback to help optimize quality performance.
  • Collaborates with others cross-departmentally to improve or streamline processes.
  • Develops new or improves current internal processes to enhance quality.
  • Maintains current knowledge of all state and federal laws or regulations affecting benefits.
  • Trains and mentors new employees as assigned.

Requirements

• High School Diploma or equivalent; some college preferred.
• 4+ years of legal compliance experience or related work experience.

Skills

• Working knowledge of applicable benefit and insurance regulations and laws.
• Proficient in computers and software skills, including Microsoft Office products.
• Strong organizational, problem-solving, and analytical skills; detail-oriented.
• Excellent written, oral, and telephonic communication skills.
• Ability to work independently, prioritize workloads, multi-task, and manage priorities to meet deadlines.
• Strong analytical and problem-solving skills.
• Ability to work effectively in a team environment.
• Ability to work in a detail-oriented environment.

Benefits

• Multiple health plan options.
• Company-paid employee premiums for disability and life insurance.
• Parental Leave Policy.
• 20 days PTO to start / 10 Paid Holidays.
• Tuition reimbursement.
• 401k company contribution.
• Company-paid short & long-term disability plus life insurance.
• Professional development initiatives / continuous learning opportunities.
• Opportunities to participate in and support the company's diversity and inclusion initiatives.