The Benefit and Contract Operations Consultant Lead will be responsible for managing collaborative work teams to maintain and execute deliverables necessary to accurate and efficient health insurance operations, ensuring timely and accurate planning, sequencing, and execution of tasks and timelines for regulatory filing, approval, and implementation for all commercial group, individual, and Medicare/Medicaid lines of business. The Lead will manage the planning, sequencing and execution of operational deliverables. They will conduct analysis and preparation of benefit plan builds and assessment deliverables to downstream configuration teams, ensure complete and timely submission of all regulatory and legal filing requirements to enable market and sale of insurance products, serve as escalation point of contact and provide guidance on responses to state regulators regarding filing objections, respond to clarification inquiries from internal partners, prepare final approved documents for production and distribution to members and groups, and maintain documentation and procedures for applicable work processes. Leads will be key stakeholders for the operations teams and will serve as primary resource for process and quality improvement, risk mitigation, operational decisions affecting assigned portfolios. Contractual documents include various product-specific iterations of Group Agreements, Evidence of Coverage, Benefit Summaries, riders, applications, and other supporting documents. Benefit plan build work involves analyzing and inputting intended plans into source database and ensuring clear handoff of build requirements to systems configuration teams. Portfolios can include commercial and individual, small and large group, shelf and custom, complex national accounts, regional strategic accounts, Federal Employees Health Benefits Plan (FEHBP), Private Exchange, Self-Funded, Medicaid, and Senior Advantage (Medicare) plans. Involves detailed benefit and business practice research, legal and regulatory reviews, summarizing recommendations and changes for technical writers, regulators, and executive approvers. Requires exceptional planning and organizational skills, ability to understand the big picture as well as ensure exceptional attention to detail, excellent written and spoken communication ability, flexibility to changing timelines and deliverable requirements, ability to multi-task, strong entrepreneurial sense of ownership, ability to influence without direct reporting relationships and drive work with a variety of stakeholders, resourcefulness, proficiency with technical systems, and ability to maintain relationships and ensure high degree of collaboration with multiple cross-functional teams.
Contractual document analysis and filing coordination: Populate templates with product-specific benefit data variables to reflect each combination of benefit plans to be filed. Assign and track appropriate form numbers. Conduct peer review / quality assurance audits for team members. Reconcile filed content to product standards and ensure that benefits are accurately reflected and comply with state and federal regulatory requirements. Create and monitor compliant SERFF filings to state regulators; communicate and escalate any status changes throughout approval process. Write filing description cover letters that include summary list of contract changes to accompany SERFF filings, in order to anticipate issues and positively influence state regulator review. Coordinate and submit responses to regulator comments. Engage with product managers, regulatory consultants and other internal subject matter experts to ensure timely and strategically appropriate positioning. Prepare final documents and related business logic forms for Contract Production. Generate product and group specific iterations of builds and documents for filing and production. Facilitate process of providing draft contracts for review to external customers / consultants, legal, account manager and other relevant stakeholders. Compile and incorporate stakeholder feedback into final forms; facilitate and communicate final approvals.Plan source build and maintenance: Analyze intent and plan requests from Products and other requesting teams. Participate in assessment conversations, provide feedback and gain clarity on requirements in order to input complete plans into source database. Enter plan details and provide handoff notes to downstream configuration teams. Provide quality assessment/validation on plans. Respond to questions, implement post handoff changes as applicable and serve as point of contact for the integrity of the plan information.Project and program management: Leads, organizes or staffs intra- and interdepartmental program and project planning. Provide direction and leadership to operations consultants and partner staffs. Facilitate planning, requirements gathering and execution of deliverables for mini-team portfolio workgroups. Oversee and manage filing, plan build and operations implementation tasks for strategic and complex accounts. Develop and maintain project plans for filing, implementation, and plan build work to meet mandatory deadlines. Proactively engage appropriate work group members, customers and SMEs in timeline negotiation and agreements. Identify gaps and opportunities across projects plans to improve timelines and assess and mitigate risks. Document and communicate status and ensure deliverables are met. Organize all documentation, decisions, materials for easy retrieval and reference using consistent format/principles. Assume ownership for deliverables and work with project teams to prioritize appropriately. Support large-scale new product or benefit development, implementation, testing efforts and lead small-scale benefit projects.Content expertise: Respond to customer or regulatory requests for information regarding contractual documents, filings and reports. Collaborate to research contract and plan portfolio changes, as assigned by peers or manager. Develop broad and nuanced understanding of product lines and benefits. Serve as subject matter expert for assigned benefits and/or product lines - respond to inquiries and maintain documentation for future self-service/reference. Develop technical SERFF and Template Automation (or similar source systems) expertise, serve as internal point of contact for related technical questions, training. Serve as reviewer and decision maker in benefit exception and custom benefit request process. Respond to requests for information on contractual documents, filings and reports during inquiries, exams, audits, disputes or negotiations.Collateral review: Review and edit marketing collateral and enrollment forms to ensure alignment with appropriate contractual documents within agreed upon timelines.Additional responsibilities: Maintain procedures and documentation for all functions performed within this position. Direct work of operations consultants and peer teams, provide mentorship and training to peers and business partners in order to help develop necessary skills and knowledge. Participate on committees and process improvement work groups, including providing testing, QA, documentation, and related support for new processes, workflows, and technical enhancements. Support operations efficiency by working with partner teams to improve input and output processes and workflows. Support complex cross-functional issue management - including identification, investigation, scoping, remediation, and communication. Support as SME and lead (where necessary) root cause analysis processes and project manage the resolution for deliverables impacting operations. Develop/maintain strong partnerships with Sales Account Management, Actuarial Services / Underwriting, Product, Benefit Management, and National/Program Office partners.
ExperienceMinimum four (4) years of project coordination and/or program management, preferably in an area related to operations, health care, contract administration, sales or product management.Minimum four (4) years in an area related to business administration, health or life insurance, contract administration, regulatory, legislative or compliance administration, insurance products, benefit policy design or related field.Minimum two (2) years in a leadership, training, coaching or mentoring role, or at least one (1) year in the Benefit and Contract Operations Consultant II role.
EducationBachelor's degree in health insurance operations, business administration, consulting or a related field OR four (4) years of experience in a directly related field.High School Diploma or General Education Development (GED) required.
License, Certification, RegistrationN/A
Excellent proficiency with computer systems and MS Office, with demonstrated ability to effectively use word processing, spreadsheet, database and presentation software.Excellent relationship development, negotiation, and change management skills - Demonstrated ability to instill confidence and respect in colleagues, develop constructive and productive working relationships with a variety of stakeholders and colleagues, gain cooperation and acceptance/approval in resolving problems, and negotiate mutually beneficial agreements between stakeholders.Strong written and verbal communication and presentation skills, including the ability to clearly and concisely explain complex information to a variety of audiences, set and measure clear expectations, address deficiencies, hold teams accountable while ensuring positive long-term working relationships.Strong research and organizational skills, resourcefulness, problem solving and critical thinking skills and ability to synthesize information from a variety of sources.Ability to work independently and efficiently under pressure with exceptional and consistent attention to detail in a deadline-driven environment.Proven ability to support colleagues and department objectives by learning new skills and demonstrated willingness to expand knowledge base.
Minimum three (3) years of experience implementing a large-scale project, product or program through multiple functional areasMinimum three (3) years of experience in a role engaged in sales, development or support of product operations.Minimum three (3) years in a leadership, training, coaching or mentoring role.Master's degree in business administration, healthcare informatics, public health policy or related field.Working knowledge of federal and state laws and regulations, ideally related to ACA (Affordable Care Act), Medicare, Medicaid provisions.Working knowledge of dynamics and trends in health insurance industry and products.Working knowledge of the technical construction of contracts or other legal or technical documents.Demonstrated knowledge of project management and process improvement principles and approaches.Demonstrated ability to use data query and analytical tools (e.g. SQL, SPSS, advanced Excel, etc.)