Self-Funded Health Plan Benefit Summary Specialist

2 weeks ago

Westborough, United States Health Plans Inc Full time
Job DescriptionJob Description

Health Plans, Inc. (HPI) is a New England-based Third-Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities, and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security.


Summary:

We are looking for a highly organized analytical team player with a working knowledge of employee benefits as they pertain to Summary of Benefits and Coverage (SBC’s). The Self-Funded Health Plan Benefit Summary Specialist is a key member of the Implementation team, facilitating client onboarding and management of SBC’s. This position is responsible for the preparation of SBC’s, utilizing writing, organizational, and administrative skills, as well as a working knowledge of creating and the universal standards set by the United States Department of Labor. The Self-Funded Health Plan Benefit Summary Specialist will ensure all SBCs represent the clients benefit plan(s) in the proper format as outlined by the United States Department of Labor (DOL). Plan SBC’s are to be completed in a timely, efficient, and accurate manner.


Duties and Responsibilities:

  • Develop, draft, and maintain the Summary of Benefits and Coverage (SBCs) for new clients upon implementation and updating renewal SBC’s for existing clients, working with Implementation and Client Services staff to ensure accurate and timely delivery of documents.
  • Understand the regulatory instructions of SBC’s, when they need to be originally distributed and or updated based on various plan changes.
  • Maintain ACA-related calculators and corresponding spreadsheets, including the SBC Calculator (used to estimate out-of-pocket expenditures for SBC coverage examples) and the MV Calculator (used to determine a Plan’s Minimum Value).
  • Incorporate updated language and provisions and maintain SBC Manual and applicable templates along with any other implementation plan-related documents as needed.
  • Update and maintain logs for tracking and distribution of SBC’s.
  • Acquire and maintain working knowledge of federal regulations such as the Affordable Care Act (ACA), IRS regulations as they relate to employee benefits, and any applicable state laws affecting clients’ plans in order to understand and interpret plan language properly in an SBC.
  • Establish and maintain collaborative rapport with Health Plans’ Client Services Department and Benefit Compliance Department staff, assisting and coordinating to resolve Plan contract-related and benefit language issues.
  • Elevating client issues and or concerns to appropriate to leadership, as necessary.
  • Identifying workflow process improvements, working with management team to implement changes.
  • Stay current on requirements under ERISA, PPACA and other related laws/regulations as it relates to SBC’s.
  • Performing other projects, assignments, and duties as assigned.
  • Perform all work in a timely, efficient, and accurate manner.


Experience and Education Requirements:

  • Bachelor’s Degree or equivalent work experience.
  • Five or more years’ related experience, preferably in the healthcare industry.
  • Health and Welfare Benefit Plan SBC drafting experience preferred.
  • Ability to understand and interpret plan documents and health plan benefit designs.
  • Proactive and deadline-driven with strong critical thinking skills and the ability to work independently.
  • Demonstrates exceptional attention to detail and accuracy while maintaining high performance in a fast-paced and dynamic work environment.
  • Must have strong written and oral communication skills.
  • Must be detailed, analytical and accurate.
  • Ability to prioritize and multi-task efficiently and accurately.
  • Ability to work both independently and as a member of the team.
  • Ability to coordinate with management as effectively as with other co-workers.
  • Ability to work within specified timeframes and meet deadlines.
  • Recognize and maintain confidentiality of work materials as appropriate.
  • Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint, Teams, SharePoint, OneDrive, and CRM platforms.

Why choose us?

  • Our space is a reflection of who we are—innovative, open and collaborative.
  • Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
  • We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks.
  • Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
  • We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
  • We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

Benefits

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our employees:

  • Medical, Dental and Vision Coverage
  • Prescription Drug Coverage
  • Fitness Reimbursement Benefit
  • Tobacco Cessation Program
  • Employee Assistance Program
  • Flexible Spending Account & Health Savings Account
  • 401(k) and Profit-Sharing Plan
  • Quarterly Bonuses
  • Generous Paid-Time Off
  • Volunteer Days
  • Education Assistance & Professional Development Opportunities
  • ….and much much more

So, think you want to join the HPI team? We hope to hear from you

You can read more about us at hpitpa.com/about-us/careers/

EEO/AA/M/F/Vet/Disability Employer

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