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Years of Experience
Date Last Verified
ProfileContract Administrator Duties: Responsible for reviewing new laws, regulations and governmental agency bulletins and circulating relevant information to areas affected, researching and writing on the impact of laws and regulations on business, drafting subscriber and provider contract language to conform with such legal requirements, and making regulatory filings and corresponding with regulators to ensure continued compliance with laws and regulations. Supports Mandate Implementation Process by tracking status within Legal of new laws and regulations, drafting Legal Affairs Bulletins for new laws and regulations, and providing legal research and writing on existing laws and regulations, as needed. Assists in maintaining and assuring the accuracy and compliance of subscriber/member contracts, provider agreements and other plan documents with state and federal laws, including submission of contracts for approval by the applicable regulatory authority. Corresponds with state insurance departments and CMS contacts to facilitate the review of product and provider contracts and maintains manuals and records of subsequently approved forms. Develops, drafts and reviews member and provider contracts, ERISA plan documents, Summary Plan Descriptions and other plan and issuer agreements. Serves on various cross-divisional internal committees to provide input on content of benefit descriptions, provider agreements, regulatory requirements with respect to contractual arrangements, and current product availability. Recommends, drafts and implements procedures that ensure timely and accurate contractual changes for all products. Maintains involvement in industry activities to keep abreast of developments in health plan contracts and compliance. Drives compliance with existing laws and regulations by partnering with Contract Administration and Product Development to align product and contract production needs with regulatory requirements. Performs other duties as assigned by management.
Qualification and Experience
Qualifications: Paralegal certification or JD Degree preferred. Bachelor’s degree. 3+ years' experience in the health care industry with an emphasis on health insurance contract preparation and/or employee benefits plan drafting. Should include product development, direct negotiating with outside entities, and primary accountability for contractual terms meeting legal requirements and business needs. Requires prior experience in analyzing and interpreting laws and regulations and drafting subscriber and provider contracts. Should include regulatory interface. Requires working knowledge of health benefits plans, state and federal laws and regulations as they apply to group contracts, insurers and familiarity with state departments of Insurance and Health and their jurisdiction over benefits plans. Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications. Effective analytical & problem solving skills to propose creative solutions to regulatory needs. Collaborative and client service focused to effectively deliver actionable requirements and solutions. Strong verbal and written communication skills to accurately and effectively describe company requirements. Must demonstrate professional and ethical business practices and adherence to company standards. Must demonstrate the ability to effectively present information and respond to questions from groups of managers, internal and external clients, and company customers. Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to adapt to new system and regulatory requirements as appropriate. Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities, deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required.
Job ID: NHP072017-10142