Employee Benefits Document Manager

• Employee Retirement Income Security Act (ERISA)
• Internal Revenue Code (Code)
• Health Insurance Patient Portability and Accountability Act (HIPAA)
• Medicare Secondary Payer Act (MSP)
• Consolidated Omnibus Budget Reconciliation Act (COBRA)
• Affordable Care Act (ACA)
• Women’s Health and Cancer Rights Act (WHCRA)

We are looking for a Junior or Senior level role. 

Junior level R

ole Responsibilities Include:

• Assisting in client implementation and client plan changes, defining clients benefits and structure for document preparation/completion for required plan document creation.
• Managing benefit plan documentation processes including:
• Conducting and managing a complete, section-by-section review of prospective conversion plan documents, including, but not limited to, Summary of Material Modification (SMM), plan amendments, and Summary of Benefits and Coverage (SBC).
• Conducting and managing a complete, section-by-section review of prospective conversion plan documents for Summary Plan Descriptions (SPD) with some feedback/assistance from Senior and/or Lead, if needed.
• Drafting, finalizing, and maintenance of standard benefit plan documents (i.e. SBCs, simple to intermediate level plan amendments) by identifying/understanding change requests and their requirements. Must have ability to identify more complex tasks and request assistance from Senior and/or Lead EBDMs when needed.
• Drafting of standard SPDs (or those that require minimal customization) with some assistance from Senior and/or Lead EBDM. Must have ability to work with and take instruction from Senior and/or Lead EBDM in order to complete SPDs that may become more involved during process.
• Identifying missing items needed for document preparation
• Submitting finalized plan documents and any changes to stop loss carriers or Stop Loss team as well as PDM vendor
• Determining changes to plan documents to ensure accuracy, seamless coverage, and any additional updates as necessary
• Managing and maintaining book of business relating to Mid-Market accounts and/or assigned projects at direction of Lead EBDM
• Stay current on requirements under ERISA, PPACA and other related laws/regulations as it relates to plan benefits
• Elevating client issues and concerns to appropriate to leadership and or Client Success team members when necessary
• May assist in training process of Analyst team members at the direction of Lead EBDM
• Performing other miscellaneous projects, assignments, and duties as assigned

Senior Level Role Responsibilities Include:

• Assisting in client implementation and client plan changes, defining clients benefits and structure for document preparation/completion for required plan document creation.
• Managing benefit plan documentation processes including:
• Conducting and managing a complete, section-by-section review of prospective conversion plan documents, including, but not limited to, Summary Plan Descriptions (SPD), Summary of Material Modification (SMM), plan amendments and Summary of Benefits and Coverage (SBC).
• Verifying eligibility status and requirements for the plan to be included in the documents
• Drafting, finalizing, and maintenance of non-standard or moderate to complex benefit plan documents (i.e. SBCs, SPDs, SMMs) with little to no assistance from Lead
• Identifying missing items needed for document preparation
• Submitting finalized plan documents and any changes to stop loss carriers or Stop Loss team as well as PDM vendor
• Determining changes to plan documents to ensure accuracy, seamless coverage, and any additional updates as necessary
• Supporting client communications, including, but not limited to, introductory calls
• Assisting Junior Members with more complex drafting requests
• Managing and maintaining book of business relating to Enterprise or Strategic accounts, but not limited to, and/or assigned projects at direction of Lead EBDM.
• Stay current on requirements under ERISA, PPACA and other related laws/regulations as it relates to plan benefits
• Elevating client issues and concerns to appropriate leadership and or Client Success team members when necessary
• Identifying workflow process improvements, working with management team to implement changes
• Assisting with client/internal departments on inquiries such as those escalated due to SPD language concerns, compliance issues, or customization requests with assistance from Lead EBDM when needed
• May assist with PDM vendor contact including discussions pertaining to federal/state mandates, governmental changes, or customized requests along with Lead EBDM
• Assist in training process of Analyst, Junior, or newly hired Senior members at direction of Lead
• Performing other miscellaneous projects, assignments, and duties as assigned

Qualifications:

Required Skills and Abilities:

• Demonstrated abilities with process development and improvement as well as change management (Sr. level)
• Strong organizational and multi-tasking skills, attention to detail
• Excellent written, verbal, and interpersonal communication skills; including ability to identify and communicate clearly on inconsistencies and issues found during drafting process
• Ability to manage time effectively, set priorities effectively, and meet deadlines
• Advanced knowledge of Microsoft Office products (Excel, Power Point, Word)
• Demonstrated ability to meet performance goals, including accuracy and productivity
• Ability to take initiative and be self-motivated while exercising proactivity and creativity in problem solving and appropriate decision-making
• Display, at minimum, intermediary level of understanding on compliance principles as it applies to document drafting and client communication
• Prior experience working on, at minimum, intermediary-level of complexity SPDs, amendments, and/or SMMs
• Team player and willingness to take instruction when necessary
• Must be able to adapt, be flexible, and have the ability to function efficiently during fast-paced work environment
• Have passion and drive in delivering quality documents
• Must have strong research and proofreading skills
• Must have ability to collaborate with both internal and external parties for issue resolution
• Ability to work independently with minimal supervision
• Typing speed of at least 60-70 WPM

Junior Education and Experience:

• 3+ years of employee benefits paralegal or similar job experience required
• 3+ years of experience in Health and Welfare benefit consulting in ERISA & Non-ERISA plans
• 3+ years of experience in client management in self-funding document creation and management
• Associate’s degree required; Bachelor’s degree preferred or equivalent job experience required
• A paralegal or related degree a plus

Senior Education and Experience:

• 5+ years of employee benefits paralegal or similar job experience required
• 5+ years of experience in Health and Welfare benefit consulting in ERISA & Non-ERISA plans
• 5+ years of experience in client management in self-funding document creation and management
• Bachelor’s degree required; paralegal or related degree preferred
• Certifications in Compliance/Insurance is a plus

Preferred Qualifications:

• Phia Group’s PDM online portal document management experience or similar use of a portal for document creation and management
• Worked with DOL Summary of Benefits and Coverage (SBCs) templates and SBC Coverage Examples Calculator
• Must have exposure to plan documents, including amendments/SMMs, in prior work environments
• Exposure to plan documents, including amendments/SMMs, in prior work environments is a plus
• Claims Litigation experience and/or Insurance related designation(s) is a plus (Sr. level)
• Prior training experience (Sr. level)

Work Location:

• An ideal candidate would be able to work from home

Pay Transparency

Our Values:

• Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up. 
• Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
• Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive. 

Who we are: