Resp & Qualifications
The Contract Specialist ensures high levels of customer satisfaction and legal compliance; achieved by ensuring contracts, templates, benefit guides, and other supportive forms are accurate and complete according to Departmental models, federal and state regulations, and guidelines so that performance goals may be met or exceeded. In general, the Contract Specialist is accountable for: 1) reviewing and accurately completing all ACA-required benefit templates and related documents; 2) assisting with the writing and filing of health insurance benefit contract forms and related forms; 3) assisting with updating and/or installing into a production environment all newly approved contract forms and documents; 4) assisting with the writing and/or auditing account specific risk and ASO benefit contracts as needed, and 45 keeping current with laws and regulations governing health insurance contract and products.
The Contract Specialist is responsible for knowing external requirements including BCBSA guidelines (including, but not limited to NMIS/MTM, NAPR, Service Mark and Blue Card), federal and state mandates, National Account (NASCO) requirements, as well as account contractual requirements, including performance standards.
The Contract Specialist is responsible for providing input to Company and Department goals and projects, evaluating procedures and processes; and recommending and implementing improvements to the way we do business.
Under the direction of the Director/Supervisor, Contracts & Compliance the essential duties and responsibilities include, but are not limited to the following:
Assists with writing, filing, and reviewing the benefit contract forms, templates, and related forms, including group account specific contracts and certificate language for risk and self-insured accounts (ASO), using established models and templates. This includes the review and preparation of all the ACA-required benefit templates.
Reviews requests (standard and nonstandard type) and interprets benefit issues; provides contract interpretation, information and language; raises complex issues to Senior Contract Specialist/Supervision in Contracting and Compliance for resolution.
Reviews Corporate Communications promotional literature, internal documents, ecommerce documents and training materials to ensure contract integrity.
Updates and/or installs into a production environment all newly approved contract forms and documents in support of contract generation. Participates in the analysis of existing business processes and systems to determine human or technical errors. Conducts research to make recommendations, assist in the preparations for testing, update SOPs and training documents. Participates in the implementation of new systems initiatives. Helps to define, document, and validate new business requirements with existing contracts and system requirements.
Clarifies and ensures consistency of contract benefits with respective system benefit coders (Care, NASCO, FACETS). Updates contract models and templates as appropriate and assigned. Audits risk and non-risk contracts, certificates and other special documents to ensure accuracy with approved forms. Responds to issues with Sales/Marketing, Underwriting, Benefits coding, Appeals Management and Membership Departments. Reviews and provides input to Senior Contract Specialist form filings.
Participates in meetings that affect contracts and certificates such as Legislative Review Committee and Team Implementation meetings and other company initiatives and projects.
Maintains and updates all department logs, contract and certificate forms; (NAEGS,etc) implements (places into production) newly approved contract forms. Maintains and loads contract upon audit completion onto the file/library; other documents to ensure contract integrity.
Additionally, there is significant responsibility and accountability with implementing templates (the approved forms). Without accurate and compliant production documents, contracts and benefit guides produced for our customers would not reflect what was purchased.
Compliant forms that are consistent with advertising, coded claims processing systems, internal training and other materials, provides for a positive public Company image and assists the Company with avoiding fines, appeals, and legal actions.
- Bachelor’s Degree or equivalent work experience in a related field demonstrating knowledge of relevant functional areas such as contract law, operations/service and claims, medical delivery, health insurance, health insurance product contract writing and/or health insurance contract production.
- 1+ years of experience in health insurance product contract review.
- 2+ years of health insurance benefit/product knowledge (indemnity and/or HMO) and benefit delivery systems.
- Demonstrated contract database systems experience, including extensive PC skills.
- The ability to manage multiple priorities simultaneously; project management.
- Travel to multiple sites (minimal) as projects dictate.
- Superior verbal and written communication skills.
- Persuasive communication with company departments, regulatory/insurance agencies and external clients and partners.
- Superior negotiation skills; ability to build consensus with a broad range of individuals and Company.
- Advanced in Microsoft Office
- Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
- SOP writing experience
- Experience with both mainframe and client/server technology
- Training experience
Benefit Contract Management
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply:
Please apply before:
Federal Disc/Physical Demand
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly to Federal health care programs.
The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The employee is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship