Health Plan Compliance Specialist

Relation Insurance Services • Tulsa, OK

4d

About The Position

The Health Plan Compliance Specialist is responsible for the creation, maintenance, and delivery of compliant health plan documentation for ERISA and non-ERISA health plans. The individual in this role ensures all plan materials meet federal and state regulatory requirements, while aligning with client benefit designs and organizational standards. The Specialist collaborates cross-functionally and participates in client implementation and renewal activities to support accurate and timely document production.

Requirements

• High School diploma or equivalent.
• Bachelor’s degree in Business, Health Administration, Public Policy, English, or related field; equivalent experience preferred.
• Strong writing, editing, and proofreading skills with attention to detail.
• Strong knowledge of employee benefits and health plan concepts (medical, Rx, dental, vision, HSA/HRA/FSA).
• Working knowledge of the laws and regulations associated with HIPAA.
• Strong knowledge of health plan design & terminology.
• Willingness to adhere to all principles of confidentiality.
• Proficiency with Microsoft Word (templates/styles), Excel, and Adobe Acrobat.
• Ability to manage multiple deadlines in a fast-paced, high-volume environment.
• Ability to work independently and follow through on deliverables.
• Excellent communication and collaboration skills.
• Proficiency with Microsoft Office (Word styles/templates, Excel), Adobe Acrobat, and redlining tools.
• 2+ years of experience working for a Third Party Administrator, health insurance broker, carrier, or benefits consulting firm in a role involving benefit plans, client implementation, compliance, or plan document preparation preferred.
• Exposure to ERISA, ACA, HIPAA, COBRA, MHPAEA, and state benefit mandates preferred.

Nice To Haves

• Familiarity with plan document generation platforms or template libraries preferred.
• Familiarity with SBC templates and plan document generation platforms preferred.
• A Life Accident and Health License from state of domicile is preferred.

Responsibilities

• Creates, maintains, and updates PHIA-regulated Summary Plan Descriptions (SPDs) and Plan Documents for ERISA and non-ERISA health plans, ensuring compliance with all applicable regulations.
• Produces Summaries of Benefits and Coverage (SBCs) in accordance with federal and state compliance requirements and ensure alignment with unique client plan design.
• Manages plan renewals and drafts plan amendments, ensuring accuracy, consistency, and timely delivery across a high-volume document environment.
• Supports the production and delivery of 80+ plan documents per month, adhering to established timelines and quality standards.
• Participates in client implementation meetings to review benefit outlines, clarify plan requirements, and gather all necessary information prior to document creation.
• Collaborates with cross-functional teams (e.g., implementation, compliance, operations) to ensure plan materials are aligned, compliant, and reflective of client expectations.
• Collaborates with the member services team leads to ensure accurate information needed to allow that team to effectively respond to member inquiries and resolve benefit-related questions.
• Serves as a liaison with Edison Health Solutions’ compliance vendors to ensure regulatory updates, template changes, and mandated federal guidelines align with contracts, benefit designs, and are incorporated into all health plan materials.
• Conducts quality reviews to confirm plan documents accurately reflect approved benefit designs and regulatory requirements.
• Maintains organized documentation records and version control in accordance with internal procedures and compliance standards.
• Assist with regulatory audits, client compliance inquiries and review related to the plan document.
• Coordinate with vendors to support required federal and state health plan filings, including but not limited to Gag Clause Prohibition Compliance (GCPCA), RxDC reporting, NY HCRA reporting, and other regulatory compliance submissions applicable to self-funded health plans.
• Conduct the preparation, validation and submission of data and documentation for mandated filings listed above.
• Maintain compliance calendars, filing records and documentation needed to support audits, client inquiries and regulatory reviews.
• Performs other projects, duties, and tasks, as assigned.

Benefits

• A safe and healthy work environment provided by our robust benefit program including family health and wellness programs, 401K, employee assistance programs, paid time off, paid holidays and more.
• Career advancement and development opportunities.

What This Job Offers

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