Regulatory Document Delivery Analyst I/II

Univera Healthcare • Rochester, NY

17d

About The Position

Summary: This position is responsible for the delivery and availability of Health Plan regulatory documents through printing and display in all electronic mediums employed by the enterprise. The incumbent ensures compliance with federal and state regulations and BCBSA in delivery of key compliance documents including, but not limited to, Subscriber Contracts, Summary of Benefits and Coverage, Medicare regulatory documents, and other customer notifications regarding product and contract updates. Essential Accountabilities: Level I Responsible for coding and maintenance of the document production system. Configures the content and documents business rule script coding to the document requirements design specifications, tests content of business rule scripts to ensure accuracy and quality for each business rule script condition statement, creates testing scripts for both content and document testing, and identifies benefit data requirements to complete testing. Adheres to all regulatory requirements and internal controls. Creates the regulatory document requirements outlining the design structure, benefit field requirements, process flow specifications and business rule script coding configuration. Develops test scripts to ensure quality and compliance for documents available both in print and via online mechanisms. Responsible for developing strategy, gaining approval and documenting requirements for the maintenance of the document production system. Ensures regulatory documents are ready for print and issued within regulatory timeframes. Analyzes requests for mandates, benefit changes, and account specific changes to determine impact to existing document production system. Identifies and documents new processes and procedures related to document production with the introduction and implementation of new technologies or system upgrades. Works in partnership with Corporate Publishing/Document Services providing document project and application requirements for naming conventions, document formats and output composition. Works with internal areas to obtain clarification of product benefits coded in benefit systems. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Leads document system configuration changes and new configuration requirements, including configuration analysis, design, build, test and documentation. Identifies, documents and works with internal staff on enhancements required to Stepwise/PCMS and the benefit XML to produce regulatory documents. Creates complex regulatory document production requirements. Determines time and resource needs and translates high level user and business requirements into detailed document configuration. Analyzes all group and product benefit and rate information support systems (e.g., Contract Development System, Stepwise, PCMS, Seibel, or membership systems). Manages implementation and mailing of group and member notices. Strategizes with management on best approach to implementing new documents or completing system maintenance. Acts in a consultative capacity to provide professional technical expertise in determination of suitable approaches to implementation and issuance of regulatory documents. Identifies and leads projects to implement approved process improvements and new technologies or system upgrades. Prepares and delivers necessary written and oral presentations. Coaches, mentors and trains less experienced team members. Oversees document system code development and production quality. Serves as the Regulatory Document Delivery system subject matter expert (SME).

Requirements

• Four or more years of relevant business systems analysis experience or Associates Degree in Computer Science, Business Administration or other relevant field with two or more years’ experience working in a technical environment. A combination of education and experience may be considered.
• Familiarity with State and Federal legislative mandates and BCBSA requirements.
• Knowledge and understanding of health insurance products with benefit detail, financial arrangements, and the Stepwise/PCMS, PEGA/SAHC or similar systems preferred.
• Demonstrated proficiency utilizing the tools and systems provided for regulatory document production.
• Detailed understanding of the functional process flows, XML structure and content, benefit systems, and document production systems.
• Ability to write and translate business and system requirements.
• Ability to identify root causes and workflow problems and determine innovative solutions and opportunities to meet process and production goals within compliance constraints.
• Excellent written communication skills including a minimum of two years’ technical or business writing experience.
• Knowledge of standard project methodology and quality testing programs.
• Strong analytical ability and problem-solving skills.
• Ability to adapt and respond to the diverse and unexpected situations normally encountered in the marketing and service occupations and maintain professionalism and poise under pressure.
• Ability to prioritize assignments, work independently and handle confidential information with discretion is essential.
• Capable of establishing constructive relationships with internal staff of all levels.
• Ability to strategize with management staff.
• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Teams, SharePoint and PowerPoint).
• Six or more years of relevant business systems analysis experience and development and coding experience or Associates Degree in Computer Science, Business Administration or other relevant field with four or more years of relevant business systems analysis experience.
• Four years of progressive regulatory document delivery development consistently demonstrating accuracy and proficiency in creating document strategy, document requirements, and implementation for both standard and complex documents.
• Extensive knowledge and understanding of the Health Plan products, benefit detail, financial arrangements, and the Stepwise/PCMS, PEGA/SAHC systems.
• Demonstrated ability to independently manage the implementation of new and innovated documents in support the corporate strategies.
• Demonstrated ability to write and code business rule scripts and to interpret, define and apply content of the benefit XML.
• Demonstrated advanced proficiency in Microsoft Office Suite (Word, Excel, Teams, SharePoint and PowerPoint).

Nice To Haves

• Bachelor’s degree preferred.

Responsibilities

• Responsible for coding and maintenance of the document production system.
• Configures the content and documents business rule script coding to the document requirements design specifications, tests content of business rule scripts to ensure accuracy and quality for each business rule script condition statement, creates testing scripts for both content and document testing, and identifies benefit data requirements to complete testing.
• Adheres to all regulatory requirements and internal controls.
• Creates the regulatory document requirements outlining the design structure, benefit field requirements, process flow specifications and business rule script coding configuration.
• Develops test scripts to ensure quality and compliance for documents available both in print and via online mechanisms.
• Responsible for developing strategy, gaining approval and documenting requirements for the maintenance of the document production system.
• Ensures regulatory documents are ready for print and issued within regulatory timeframes.
• Analyzes requests for mandates, benefit changes, and account specific changes to determine impact to existing document production system.
• Identifies and documents new processes and procedures related to document production with the introduction and implementation of new technologies or system upgrades.
• Works in partnership with Corporate Publishing/Document Services providing document project and application requirements for naming conventions, document formats and output composition.
• Works with internal areas to obtain clarification of product benefits coded in benefit systems.
• Leads document system configuration changes and new configuration requirements, including configuration analysis, design, build, test and documentation.
• Identifies, documents and works with internal staff on enhancements required to Stepwise/PCMS and the benefit XML to produce regulatory documents.
• Creates complex regulatory document production requirements.
• Determines time and resource needs and translates high level user and business requirements into detailed document configuration.
• Analyzes all group and product benefit and rate information support systems (e.g., Contract Development System, Stepwise, PCMS, Seibel, or membership systems).
• Manages implementation and mailing of group and member notices.
• Strategizes with management on best approach to implementing new documents or completing system maintenance.
• Acts in a consultative capacity to provide professional technical expertise in determination of suitable approaches to implementation and issuance of regulatory documents.
• Identifies and leads projects to implement approved process improvements and new technologies or system upgrades.
• Prepares and delivers necessary written and oral presentations.
• Coaches, mentors and trains less experienced team members.
• Oversees document system code development and production quality.
• Serves as the Regulatory Document Delivery system subject matter expert (SME).

Benefits

• participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 251-500 employees