Provides analysis to develop, design, implement, maintain and support new/ existing product and benefit system administration both internally and with external vendors. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to Membership/Benefit Administration; Marketing, Sales and Business Development; Care Delivery; and Claims Administration. Maintains knowledge of and assures departmental compliance with Kaiser Permanente's Principles of Responsibility and policies and procedures, and applicable regulatory requirements and accreditation standards. Responds appropriately to observed fraud or abuse.
Analyzes and interprets benefit/plan related documentation to include, but not limited to state and federal legislation.
Provides recommendations to implement and administer new/existing products and benefits considering customer, clinical, pricing and regulatory implications.
Provides professional/technical guidance and training to team to implement and administer new/existing products and benefits.
Documents benefit/plan requirements, creates, implements and maintains benefits/plans to meet regulatory and internal/external benefit administration needs.
Maintains and updates Benefit Administration systems/databases, e.g. web-based and legacy systems, with complex detailed benefit information to support products, benefits, membership, contracts, claims and care delivery.
Ensures benefit/plan information quality and compliance. Develops and performs quality assurance processes.
Knowledgeable in all applicable Kaiser policies, local, state and federal laws and regulations, and accreditation standards.
Acts as a source-matter expert for benefits.
Troubleshoots benefit issues daily and recommends/implements solutions.
Interacts, coordinates, influences a wide variety of internal customers to include, but not limited to: Sales, Product Development, Underwriting, Contracts, Claims, and KP HealthConnect.
Data management through creation of spreadsheets and reports in Microsoft Excel and Access.
Selects methods and techniques for obtaining technical solutions for design, development and implementation of new and improved processes, tools and system enhancements.
Performs Project Lead role for Benefit Administration projects as needed. Creates and manages project tasks and milestones as they relate to the Benefit Administration team.
Prepares training materials and communication updates and conducts training both in a group and one-on-one setting.
Assists with data validation, auditing and user acceptance testing.
Participates in regional or national projects as assigned.
Other duties as assigned.