Job Description
Resp & Qualifications
PURPOSE:
This role supports Benefit Contract Management (BCM) by assisting or performing tasks that include but are not limited to: revising/updating contract forms and templates; reviewing contract forms, templates and related marketing materials; preparing electronic filings via SERFF; tracking status of filings; creating sample contracts; creating Evidence of Coverage (EOCs); creating Summary of Benefit Coverage (SBCs); assisting Sales and Product with contract related matters; interacting with state Regulators; organizing and circulating contract related documents; and contributing to BCM strategies and process improvements.
ESSENTIAL FUNCTIONS:
- Reviews, clarifies and/or interprets customized/nonstandard benefit requests; provides information and decisions to operations, account implementation meetings, and other company initiative implementation meetings needed. Clarifies and ensures consistency of contract benefits with respective system benefit coders. Revises/updates contract forms and templates as appropriate. Assist or performs electronic filings via SERFF.
- Reviews requests (standard and nonstandard) and interprets benefit issues; provides contract interpretation, information and language; escalates complex issues to Senior Contract Specialist/Benefit Contract Management (BCM) leadership for resolution.
- Maintains and updates all department logs, contract and certificate forms; implements (places into production) newly approved contract forms.
- Revises group account specific contracts and certificate language for risk and self-insured accounts using established models and templates when available. Maintains and uploads contracts upon audit completion into the file/library and other documents to ensure contract integrity.
- Provides support on compliance matters by investigating, responding to, and taking corrective actions as needed.
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: 3 years experience health insurance benefit/product knowledge and benefits delivery systems
Knowledge, Skills and Abilities (KSAs)
- Strong time-management and organizational skills.
- Excellent communication skills both written and verbal.
- Ability to organize and lead stakeholder meetings.
- Proficient in Microsoft Office applications.
- Knowledge of health insurance products.
- Strong attention to detail.
Salary Range: $54,216 - $107,679
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 responsibilities 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).
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.
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.
#LI-LJ1
Resp & Qualifications
PURPOSE:
This role supports Benefit Contract Management (BCM) by assisting or performing tasks that include but are not limited to: revising/updating contract forms and templates; reviewing contract forms, templates and related marketing materials; preparing electronic filings via SERFF; tracking status of filings; creating sample contracts; creating Evidence of Coverage (EOCs); creating Summary of Benefit Coverage (SBCs); assisting Sales and Product with contract related matters; interacting with state Regulators; organizing and circulating contract related documents; and contributing to BCM strategies and process improvements.
ESSENTIAL FUNCTIONS:
- Reviews, clarifies and/or interprets customized/nonstandard benefit requests; provides information and decisions to operations, account implementation meetings, and other company initiative implementation meetings needed. Clarifies and ensures consistency of contract benefits with respective system benefit coders. Revises/updates contract forms and templates as appropriate. Assist or performs electronic filings via SERFF.
- Reviews requests (standard and nonstandard) and interprets benefit issues; provides contract interpretation, information and language; escalates complex issues to Senior Contract Specialist/Benefit Contract Management (BCM) leadership for resolution.
- Maintains and updates all department logs, contract and certificate forms; implements (places into production) newly approved contract forms.
- Revises group account specific contracts and certificate language for risk and self-insured accounts using established models and templates when available. Maintains and uploads contracts upon audit completion into the file/library and other documents to ensure contract integrity.
- Provides support on compliance matters by investigating, responding to, and taking corrective actions as needed.
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: 3 years experience health insurance benefit/product knowledge and benefits delivery systems
Knowledge, Skills and Abilities (KSAs)
- Strong time-management and organizational skills.
- Excellent communication skills both written and verbal.
- Ability to organize and lead stakeholder meetings.
- Proficient in Microsoft Office applications.
- Knowledge of health insurance products.
- Strong attention to detail.
Salary Range: $54,216 - $107,679
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 responsibilities 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).
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.
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.
#LI-LJ1
About CareFirst BlueCross BlueShield
Named by the Ethisphere Institute as one of the “World’s Most Ethical Companies” for 10 consecutive years.
CareFirst. It’s not just our name. It’s our promise. Over 3.5 million people trust us with their healthcare needs, and we take this responsibility seriously.
Our vision for healthcare is clear. Quality care should be easy to afford, easy to use and available to everyone. And what we’re building for you is exactly what we expect for ourselves and those we love.
Every day, we make a meaningful difference in the communities where we live and work. We solve real problems for the people we serve with equal parts empathy and urgency—simplifying the complex, delivering tailored solutions and stepping forward with new ideas.
RECRUITMENT FRAUD NOTICE: CareFirst is aware of an increase in fraudulent job offers being made on behalf of our recruitment team. Legitimate CareFirst recruiters will always contact you from an email address ending in “@carefirst.com” and will never ask for a payment in exchange for a job opportunity or ask you to submit sensitive personal information via email, phone, or text.
COVID-19 VACCINATION NOTICE: As a leading healthcare organization, it is our responsibility to do our part to help end this pandemic and protect the health and well-being of our members, workforce, communities, businesses and partners. Our recruiters continue to fill open positions. Interviews and other processes are being modified to protect the safety of our candidates and team members. Effective November 1, 2021, COVID-19 full vaccination is required for all employees, including those who work remotely today or in the future. CareFirst will comply with all state and local laws regarding vaccine mandates. Medical and religious exemptions will be made where appropriate using our standard vaccine exemption processes.
Independent licensee of BCBSA.
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