Contract Production Specialist

Description

Position Purpose: This position is responsible for the issuance and auditing of group contracts, certificates of coverage, schedules of benefits, agreements, summaries of benefits and coverage, amendments, consumer driven product summary plan descriptions, and Level Solutions summary plan descriptions and other contractual documents, as applicable.  Works with internal staff to ensure that these documents comply with state and federal regulations. Also, as a back-up to the SBU & Group Implementation Manager, assists with other contracting duties as needed.  In addition, backs up the Implementation team on other functions as assigned. 

Primary Responsibilities:

1. In Q2E tool, audits group contracts, certificates of coverage, Medicare creditable coverage letters, and agreements, according to employer group specifications, and establishing, maintaining, and updating files if needed.
2. Generates production-ready group schedules of benefits, and summaries of benefits and coverage, and amendments, according to employer group specifications, and establishing, maintaining, and updating files containing same.
3. Generates production-ready Level Solutions summary plan descriptions, schedules of benefits, summaries of benefits and coverage and summary of material modifications according to PHP requirements, and establishing, maintaining, and updating files containing same.
4. Generates production-ready consumer driven product summary plan descriptions and amendments according to employer group specifications, and establishing, maintaining, and updating files containing same.
5. E-mails consumer driven product summary plan descriptions, agreements and amendments to employer groups and brokers as needed.
6. Creates templates for group documents, for each contract holder, in accordance with forms and language properly filed with the Indiana Department of Insurance and Ohio Department of Insurance. Chooses appropriate contract language within approved contract variables.
7. Creates templates for Level Solutions summary plan descriptions for each contract holder, choosing appropriate language within variables. 
8. Uploads completed documents to the web, initiates automated e-mails to groups and brokers, and confirms files are appropriately loaded for notification to members.  
9. Assists with maintenance of the Benefit Plan Tool, which includes adding new plans, auditing plans and marking plans as sold.
10. Identifies and follows-up on variances in renewal and new group information to ensure accuracy of group set-up.
11. Conducts monthly audits of the Group Implementation Specialists’ data entry in the following systems:  Microsoft Dynamics, and Q2E.
12. Coordinates the requests for translation of Sales Department documents.
13. Develops and implements contract operating procedures.
14. Proofreads and edits draft and final copy materials of group certificates of coverage, schedules of benefits, and summaries of benefits and coverage, agreements and consumer driven product documents for appropriate and consistent format, accuracy, correct punctuation, spelling, and grammar.  In addition, assists with other audits as needed including the audit of Level Solutions contracting documents.
15. Prints, emails or mails non-electronic contract documents to the broker.
16. Uploads department records (group variable information, consumer driven product documents, and Level Solutions documents) into the document storage system.
17. With assistance from Actuarial and Compliance staff, updates and submits contract/form filings for group products to the Indiana Department of Insurance and Ohio Department of Insurance, via SERFF.
18. Maintains primary responsibility for broker contracting and broker database administration within Q2E.
19. Prepares and delivers Individual or Corporate Brokerage Agreements for newly appointed brokers, updating the broker data in Q2E upon return of the contracts, and remitting the executed copy of the contract to the broker.
20. Maintains current broker information, including licensing information.
21. Processes Agent of Record changes by sending notification to affected brokers.
22. Collaborates with internal customers to resolve problems.
23. Coordinates and monitors process flow and turnaround times of benefit contracts and associated documents.
24. May serve as a team member on various project teams.
25. As a back-up to the SBU & Group Implementation Manager, assists with other contracting duties as needed.\
26. Continues professional growth and development by keeping abreast of current managed care, insurance, and industry trends to assist with position requirements.
27. Participates in company-wide and departmental quality management activities.
28. Participates in training on federal and state regulations applicable to position, and adheres to same.
29. Performs any relevant and related duties as required.

Qualifications

Critical Required Skills:

1. Thorough understanding of managed health care from a business perspective.
2. Strong contract-based background, with knowledge of benefit contracts and the ability to draft contract language.
3. Strong verbal, written, and interpersonal communication skills, including excellent listening skills.
4. Proficient skills in Microsoft Office and other programs (especially Word, Excel, and Access), including an ability to troubleshoot.
5. Must possess a high level of accuracy, with the ability to proof and edit.
6. Excellent organizational skills needed to plan, coordinate, and prioritize multiple projects and tasks concurrently.
7. Maintenance, filing, and retrieval of information/documents.
8. Ability to use standard office technology (fax machines, copiers, voicemail, etc.).
9. Must be able to work independently as well as participate as a team member in cross-departmental collaborative efforts.

Key Challenges:

1. Self-management is needed to plan, prioritize workload, integrate and coordinate contracting initiatives.
2. Ability to remove roadblocks in order to ensure a smooth contracting process.
3. Accurately and effectively managing large amounts of information.
4. Must be able to: 1) develop goals, objectives, policies and procedures, and 2) interpret relevant legal requirements.
5. Keeping up-to-date on state and federal laws and regulations.
6. Improving benefit contract language to provide for ease of administration and cost effectiveness.
7. Must always project a positive attitude toward PHP and its services.
8. Maintaining effective relationships with employees at all levels.
9. Working against specific expectations, deadlines, and time requirements.
10. Working independently as well as within a team in support of corporate objectives and quality service.

Experience: A High School Degree or equivalent. Three to five (3-5) years of managed health care or related experience, preferably in the legal area with contract and legal terminology and/or familiarity with health care benefits and benefit administration. Proficient skills in Microsoft Word and other Microsoft Office applications required. Paralegal or college level coursework in law or business is preferred. This individual should have a demonstrated ability to accurately plan, organize, prioritize, and implement efforts and must be able to function effectively within a fast-paced environment. Maintaining an active licensure as an Insurance Agent in the State of Indiana is preferred. This individual should demonstrate increasing ability to use computers and technology to enhance and improve processes for efficiency and effectiveness.

Position Constraints: This individual must function effectively in a stressful, time-oriented, customer service environment. Majority of time is spent on visual, mental, and seated work. Working on multiple projects/problems simultaneously. Working within a specific deadline-driven environment. Small amounts of light lifting (e.g., supplies, paper, etc.). Moderate to heavy typing on a PC.