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Resp & Qualifications
Under the direction of the Director of Benefit Contract Management or the Manager of Benefit Contract Forms as assigned:
Drafts group and individual, indemnity and HMO, contracts and certificates for risk and self-insured accounts (ASO Administrative Services Agreements, other amendments, etc., e.g. Shared Processing, etc.) to successfully support the Company’s health, life, and disability insurance business in the marketplace. Formats and drafts contracts and documents in defined Departmental form and style. Timely files forms with the respective Insurance Administrations as needed and responds to Insurance Administration inquiries, comments, and disapprovals. Also timely files all forms with other appropriate regulatory agencies (CMS, DOL, Maryland DHMH, BCBSA, etc.) as appropriate also to ensure legal compliance of forms.
Consults with the Legal Staff, Government Affairs, Mandates, Pricing, Underwriting, and other Departments or stakeholders as necessary. Review and research, as appropriate, local and federal code and regulations, state bulletins, and other guidance via Internet and other Department resources.
Analyzes proposed product designs and changes to health, life, and/or disability contract forms and documents, and provides input to the respective workgroups and Departments (i.e. Marketing, Pharmacy, Medical Policy, Underwriting).
Implements newly filed and approved forms and created master templates into a contract generation production environment; which includes, but is not limited to creating production forms and templates, drafting implementation documentation to provide detailed implementation instructions, and reviewing sample contracts for accuracy.
Reviews, interprets, and responds to account-specific RFPs, RFIs, and other customized requests (nonstandard contracts) to determine if existing contract forms can support the customized request. Drafts and files with regulators, group account specific contracts and certificate language as needed.
Creates, manages, and implements benefit contract templates, financial contract templates, production documents, and account-specific customized benefit contracts as applicable.
Manually creates or assists with the creation of sample contracts as needed.
Effectively communicates contractual changes to all impacted internal Departments and workgroups that result from medical policy/legislative/marketing product design changes; track/log accordingly inquiries and projects.
Maintains current project files and master logs of forms and requested revisions (i.e. Change Log, Corporate Log, Master Document Listings, etc.).
Audits contracts and other special documents to ensure accuracy and resolves issues with necessary departments. Participate and/or leads in Company initiative implementations/projects and operational meetings and other meetings that affect contracts and certificates such as the Legislative Review Committee and Team Implementation Meetings. Audits Account Installation master documents and procedures for compliance.
Represents the Department and Company in Insurance Administration Market Conduct Studies and other audits; and responds appropriately.
Meets and/or communicates directly with accounts and/or their staff as needed (assists Sales and Underwriting in this regard); performs other duties as requested.
Clarifies and ensures consistency of contract benefits with respective system benefit coders (CARE, NASCO, FACETS); provides review sign-off as needed.
Responds to Insurance Administration inquiries; completes Insurance Administration surveys as needed and assigned. Works with Central Appeals Unit, Executive Inquiry, Corporate Audit and other department inquiries that are of an ‘elevated’ status.
Researches and assists with the resolution of benefit and/or financial contract issues. Also, in collaboration with the Legal Team, assists with the resolution of complex issues and benefit interpretations as necessary.
Reviews Corporate Communications promotional literature, internal documents, ecommerce documents and training materials to ensure contract integrity.
Department: Benefit Contract Management
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 6/1/2018
Federal Disc/Physical Demand
Note: The applicant is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The Associate is primarily seated while performing duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key, and handle or feel small controls and objects. The employee must frequently talk, see and listen. Weights of up to 25 pounds are occasionally lifted.
The physical demands described here are representative of those that must be met by an Associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship