Contract Specialist I

Moda Health•Portland, OR

3d•Remote

About The Position

The Contract Specialist I serves as a subject matter expert on health plan contracts and prepares high volumes of medical and dental plan documents for standard and non-standard groups. Work must meet company specifications and turnaround requirements and comply with applicable state and federal laws and regulations. The role also produces Summary of Benefits and Coverage (SBC) and Plan Change Form documents. This is a full-time work-from-home role. The position analyzes source documents, prepares and audits plan documents, communicates with internal departments about questions and requested changes, and maintains group files and work logs. It works in an office environment involving extensive computer and keyboard use, sustained sitting, frequent phone communication, and navigation of multiple computer screens. A reliable high-speed, hard-wired internet connection is required for remote or hybrid work, and the employee must be comfortable appearing on camera for virtual training and meetings. Work beyond the standard workweek, including evenings and occasional weekends, may be required to meet business needs.

Requirements

Bachelor’s degree or a combination of college-level coursework and relevant experience.
Demonstrated proficiency with Adobe and Microsoft Office applications, including Word and Excel.
Minimum typing ability of 35 words per minute.
Effective verbal, written, and interpersonal communication skills.
Ability to identify problems and initiate solutions.
Ability to initiate and follow departmental policies and procedures.
Ability to work under pressure and adapt to changing priorities.
Ability to learn new information and apply it to a variety of situations.
Strong organizational skills, including the ability to prioritize and meet deadlines.
Ability to maintain confidentiality and project a professional business image to internal and external customers.
Ability to report to work on time and daily.
A reliable, high-speed, hard-wired internet connection to support remote or hybrid work.
Comfort appearing on camera for virtual training and meetings.

Nice To Haves

One to two years of insurance experience, preferably in Claims and/or Customer Service.

Responsibilities

Analyze and understand source documents, including Group Applications; identify potential errors, research as appropriate, and correct inaccurate information.
Accurately prepare plan documents for new and renewing standard and non-standard groups.
Learn and understand company products, including annual changes and new products, and how they relate to plan documents.
Understand the differences between standard and non-standard language.
Serve as a subject matter expert and respond to internal department inquiries regarding plan documents.
Identify discrepancies between source documents and Contract department records and communicate questions to relevant internal departments.
Communicate with internal departments about requested changes to plan documents.
Document actions taken and maintain group files and work logs.
Assist in developing policies and procedures.
Produce Summary of Benefits and Coverage (SBC) and Plan Change Form documents.
Perform peer audits and self-audits of plan documents for accuracy.
Produce quality work within short turnaround times and meet department productivity and accuracy standards.
Support peers in a team structure.
Train lower-level staff, including temporary staff.
Perform other duties as assigned.