Benefit Contrct Anlyst

Cambia Health Solutions • Portland, OR

11d • Hybrid

About The Position

Every day, Cambia’s dedicated team of Benefit Contract Analyst s is living our mission to make health care easier and lives better. As a member of the Benefit Contract team, our Benefit Contract Analyst (BCA) is responsible for the development and filing of regulatory benefit materials for members and groups. These materials include benefit booklets, contracts, policies, schedules of benefits (SOBs) and Summary of Benefits and Coverage (SBCs) for standard individual, small group, and large group, as well as negotiated large group fully underwritten and self-funded plan documents/summary plan descriptions. A BCA develops benefit language, collaborates with Legal and Product, coordinates the filing of regulatory documents with state insurance divisions, analyzes insurance division objections, organizes responses and completes filing resubmission functions – all in service of creating a person-focused health care experience. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

Requirements

• Bachelor's degree in healthcare, English, business or health care administration, communications and 3 years work-related experience or equivalent combination of education and experience.
• Possesses significant organizational skills with a demonstrated ability to prioritize, coordinate and implement multiple projects within varied or simultaneous time constraints and deadlines.
• Coordinates language drafting and document production activities with all levels of staff within the organization and with external agencies through clear and concise verbal and written communication skills, including tactful and persuasive negotiation skills.
• Demonstrated ability to work independently, exercise sound judgment, and develop collaborative and effective working relationships with internal and external business partners, including, but not limited to, Sales, Sales Operations, Product and the Insurance Division.
• Fearlessly takes on new challenges in a changing insurance and corporate environment.
• Comprehends and masters the drafting of all aspects of the regulatory health benefit documents for fully-insured lines of business and custom groups.
• Highly proficient in Windows applications, including Word.
• Comfortable working in high-pressure circumstances, with multiple concurrent projects involving multidisciplinary, distinct tasks, and a proven ability to initiate and independently produce detailed and highly accurate work.
• Must be able to work with minimal supervision and assume increasingly complex responsibilities.
• Exhibits knowledge of the health insurance industry, including benefit design and compliance concerns. This may include an understanding of federal laws and guidelines, such as the Affordable Care Act (ACA), COBRA, HIPAA and state health insurance code and regulations.
• Candidates must reside within commutable distance of that location.
• Must have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
• New hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company.

Nice To Haves

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• Creates and develops benefit language for new health insurance products, programs and services in response to federal and state regulations and marketplace changes.
• Negotiates and coordinates with internal and external business partners to develop, write, revise, and coordinate group and member benefit booklets, contracts, policies, summaries of benefit coverage, and all other regulatory documents for Individual, Small Group, Large Group, Administrative Services Only, Medicare Supplemental, Dental and Vision plans.
• Ensures that legal documents and contracts are legally compliant, complete, professionally written and understandable
• Oversee and track regulatory submissions
• Establishes and maintains an effective working relationship with the Insurance Department to ensure timely submission of regulatory compliant form filings, managing them until insurance division approval is received.
• Validates regulatory filings prior to and following the submission with the Insurance Departments in Idaho, Oregon, Utah, and Washington.
• Manages regulatory objections by analyzing insurance division requests, researching options, negotiating response language, and submitting timely replies.
• Cultivates and maintains relationships with key internal and cross-divisional teams, as well as external customers, including producers, groups and Insurance Department contacts.
• Researches and responds to requests for interpretation of benefits within the health benefit materials.
• Demonstrates initiative and analytical ability in identifying problems, researching issues, developing solutions, and implementing a course of action.
• Listens and communicates appropriately in a manner that promotes positive, professional interaction while preserving confidentiality and sensitivity in all aspects of internal and external contacts.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level