Benefits & Materials Analyst

Viva Health•Birmingham, AL

20d•Onsite

About The Position

The Benefits & Materials Analyst position oversees the maintenance of our Medicare Advantage plans and benefits. This role participates in the annual bidding process, helps create and submit plans to Medicare and develops/updates certain plan materials for the coming year. This position also performs oversight for specific vendor services included in Medicare Advantage benefit packages.

Requirements

Bachelor’s degree in relevant field or at least 2 years of experience in benefit design or member material development
Excellent written and verbal communication skills
Demonstrated critical thinking skills
Excellent proofreading skills
Detail orientation and willingness to check and double check key benefit information
Strong technical skills to improve efficiency and reduce human error in the production of member materials including proficiency with MS Office Word, Excel, and Power Point as well as working knowledge of Adobe Acrobat or ability to gain such knowledge quickly
Ability to work overtime during peak times and avoid voluntary time off to ensure critical deadlines are met

Nice To Haves

Health plan experience, especially in benefit design or member materials and/or in Medicare Advantage
Project management experience
Demonstrated expertise in facilitating diverse teams
Project management experience or understanding of project management methodology

Responsibilities

Provide analysis, identification, and selection of vendors that are being considered to provide services for the Medicare Advantage plans. This includes requests for proposals (RFP) development, coordination, and analysis.
Participate on the team that completes Medicare bids each year to ensure bids are submitted accurately and on or before the Centers for Medicare & Medicaid Services (CMS) deadline.
Provide input to the group regarding proposed changes to current plan designs and any new plan offerings being considered.
Participate in the workgroup that completes the Plan Benefit Package (PBP) data entry to reflect any plan changes from the prior year and make additional changes to the PBPs as needed based on CMS guidance and changes to the PBP tool itself.
Help upload the bid worksheets provided by the actuaries and the PBP data to CMS by the CMS deadline for the next calendar year.
Revise and re-upload data on or before the CMS deadline, if necessary, based on CMS and actuary feedback.
Following bid submission, customize the model member materials provided by CMS to reflect the plan designs VIVA HEALTH submitted.
Guide project teams to map PBP data to member material to reduce manual data entry. This includes Annual Notices of Changes (ANOCs), Evidences of Coverage (EOCs) and Medicaid Amendment.
Also coordinate mid-year EOC amendments when required.
Ensure member materials are completed accurately and submitted to CMS in time to meet applicable CMS deadlines for distribution.
Populate limited income subsidy (LIS) rider spreadsheet annually to ensure premium, deductible and copay/coinsurance amounts are calculated correctly to assist in the creation of the LIS Riders.
Assist in proofing other member materials describing plan benefits as requested, such as new benefit guides/flyers, copay sheets, summaries of benefits, drug formularies, provider and pharmacy directories, website information, etc.
Assist in the development and presentation of employee training regarding benefit changes for the upcoming open enrollment season as requested.
Provide assistance in submitting service area expansion applications, new product applications, and the state Medicaid Agency agreements to CMS when applicable.
Coordinate implementation of new vendors as assigned.
Perform on-going monitoring and/or auditing of assigned vendors to ensure vendor functions are consistent with contractual and regulatory obligations.
Report results of monitoring/auditing activities to the vendor and internal stakeholders.