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, National Account (NASCO) requirements, 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:
None (However, accountable for training new Senior Contract Specialists, and providing informal training, guidance and assistance to Contract Specialists and other Company Associates.)
This position provides critical support to the Company as it provides the source information and documentation for all benefit administration decisions for all products marketed by CareFirst (excluding BCBSDE). The Contracting and Compliance Department is the ‘source’ for much of the information that CareFirst relies upon to accurately and effectively implement and administer its health insurance product portfolio. The base ‘product’ of the Company – health insurance – cannot be delivered without this responsibility. Insured contracts cannot be issued to customers until written, filed and approved with appropriate regulators. Without approved contracts, the Company cannot sell its products.
Additionally, there is significant responsibility and accountability with implementing templates (the approved forms). Without accurate and compliant production documents, contracts and benefit guides produced for our customers would not reflect what was purchased.
There is significant responsibility as there is regular contact with Insurance Regulators; the Senior Contract Specialist is representing the Company. Further it is the responsibility of the Senior Contract Specialist to ensure that appropriate contract filings occur as mandates and other legislation is effective to ensure compliance of all contract forms.
Compliant forms, consistent with advertising, coded claims processing systems, internal training and other materials, provides for a positive public Company image and assists the Company with avoiding fines, appeals, and legal actions.
• 4+ years of Health insurance benefit/product knowledge (indemnity and/or HMO) and benefit delivery systems, or extensive (technical or contract) writing experience
• Bachelor’s Degree, or equivalent work experience in a related field demonstrating knowledge of relevant functional areas such as: contract law, operations/service and claims, medical delivery, health insurance, health insurance product contract writing
• demonstrated knowledge of local jurisdictional (service area) and federal laws and regulations that govern the health insurance industry
• the ability to manage multiple priorities simultaneously; project management
• travel to multiple sites (minimal) as projects dictate
• Proven judgment and decision-making ability; must be able to make and carry out a broad range of decisions while remaining consistent with Company and regulatory guidelines
• Superior verbal and written communication skills; excellent reading comprehension (ability to read, understand and apply laws, codes and regulations to projects, the Company product portfolio and the business environment); above average attention to detail
• Evaluate demands on time and resources effectively; establish appropriate priorities; manage multiple priorities and respond appropriately to unplanned events
• Presentation skills to be able to represent the Department persuasively and articulately in meetings with other Company departments, regulatory/insurance agencies and external clients and partners
• Flexibility with superior negotiation skills; ability to build towards consensus with a broad range of individuals and Company departments
• Superior organizational and follow-up skills
• Average to above average ability with Microsoft Office; ability to navigate the internet to locate local and federal codes and regulations used as resources
• Juris Doctorate (J.D.), with four 4+ years extensive writing experience
• Attorney; degree in Law, Health Care Administration, or related field; Paralegal.
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: 6/13/2020
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