Resp & Qualifications
Ensures high levels of customer satisfaction and legal compliance; achieved by ensuring master templates needed for the generation of all health insurance contracts, benefit guides and other supportive forms are compliant, accurate and complete according to Departmental models and guidelines so that Department and Company performance goals may be met or exceeded. The Senior Contract Specialist is accountable for: 1) writing and filing all health insurance contract and related forms (Member Applications, Group Applications, Stop Loss Contracts, etc.) with all Insurance Administrations and other regulators as appropriate, 2) updating and/or installing into a production environment all newly approved forms and documents, 3) writing and/or auditing account specific risk and ASO benefit contracts as needed, and 4) keeping current with laws and regulations governing health insurance contract and products.
The Senior Contract Specialist is responsible for knowing external requirements including BCBSA guidelines (including, but not limited to NMIS/MTM,NAPR, Service Mark, and BlueCard), federal and state mandates, CFA/NCAS requirements (as applicble), as well as account contractual requirements, including performance standards.
The Senior Contract Specialist is responsible for working closely with the Legal Department to ensure contract form compliance, and with Marketing and other Implementer in providing input to Company and Departmental goals and projects, and evaluating procedures and processes, to recommend and implement improvements to the way we do business.
Under the direction of the Manager of Contracting and Compliance:
1. Writes 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.). Files all forms with the respective Insurance Administrations and responds to comments and disapprovals. Files all forms with other appropriate regulatory agencies (CMS, DOL, Maryland DHMH, BCBSA, etc.) as appropriate also to ensure legal compliance of forms as known.
Responds to Insurance Administration inquiries; completes Insurance Administration surveys as needed and assigned. Responds to Central Appeals Unit, Executive Inquiry, Corporate Audit and other department inquiries that are of an ‘elevated’ status.
Formats and writes documents in defined Departmental form and style.
Consults with the Legal Staff, Government Affairs and other departments as necessary. Researches appropriate local and federal code and regulations via internet and other Department resources.
Implements newly ‘approved’ forms master templates into a production environment; produces all production forms; writes and maintains implementation documentation, and provides detailed implementation instructions.
Maintains current project files and master logs of forms (example: Corporate Log, Master Document Listings, etc.).
2. Audits Contracts and other special documents to ensure accuracy and resolves issues with necessary departments. Participates/leads in Company initiative implementation and Operations meetings and other meetings that affect contracts and certificates such as the Legislative Review Committee and Team Implementation Meetings; participates in the implementation of other Company initiatives and projects. Audits Account Installation master documents and procedures for compliance.
Represents the Department and Company in Insurance Administration Market Conduct Studies and other audits; responds appropriately.
Meets and/or communicates directly with accounts and/or their legal 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; provides review sign-off as needed.
3. Interprets benefit issues, provides contract interpretations; resolves complex issues and benefit interpretations with the Legal staff, Health Care Policy, etc. as necessary.
4. Reviews, interprets and responds to account specific RFPs, RFIs, and other requests (nonstandard type) and writes and files with regulators, group account specific contracts and certificate language as needed. Produces and implements account specific production forms for customized benefits.
5. Reviews Corporate Communications promotional literature, internal documents, ecommerce documents and training materials to ensure contract integrity.
6. Analyzes proposed product designs and changes to product designs and provides input to the work groups and Marketing and Product Development that define same.
7. Effectively communicates contractual changes to all affected internal personnel that result from medical policy/legislative/marketing product design changes; track/log accordingly inquiries and projects.
Department: TPA Contracts
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: 10/25/2018
Federal Disc/Physical Demand
Note: The incumbent 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 the 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 associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship