Benefit Documentation Coordinator

Job Description

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships within our team and with our clients.

General Summary

This position will serve as the main source of creating and maintaining all client documentation housed within the Account Management Division.

Principal Duties And Responsibilities

Contract Specs

• Maintaining tracking sheet of renewal dates ("Renewal Date CLIENT LIST"), regularly distributed to Reinsurance and Accounting depts.
• Creating/maintaining individual groups' Contract Specs files
• Creating new, renewal, revised, and term specs using the following as source docs: reinsurance proposals and applications, Implementation Guide, other plan's renewal proposals for COBRA admin, Admin Services Agreement, collected emails from and consultations with Sales/AE/Accounting/Eligibility/Vendor Relations, Consociate Consolidated Contact List, term notices/Agreements, rate notification changes from Vendors.
• Review/evaluation of renewal information based on anticipated plan changes, vendor changes, reinsurance, or reinsurer changes.
• Creating/maintaining specs projects in Monday.com
• Tracking approvals/requested revisions until final distribution.
• Distributing on Monday.com and maintaining h-drive Specs repository files
• Specs template maintenance/revisions based on compliance needs, plan designs, Vendor PEPM/PPPM requirements on invoices or vendor claims, consultations with Reinsurance/Ops/Accounting/Vendor Relations departments and Account Executives.
  
  

SPDs

• Creating/maintaining group's SPD files in Account Management folder, which includes all SOBs, source docs, drafts, special requests.
• Maintaining/revising templates used for SOBs (separate 1, 2, 3, and 4 tier templates)
• Creating SPD in Phia's PDM (Plan Doc Management system) using the following as source docs: specs, SBCs, Implementation Guide, ID cards, SOBs, plan build notes, collected emails about singular plan issues, previous group documents including Personnel Manual, SPD, SBCs
• Making corrections to standard template errors
• Revising initial creation with required language for additional items like domestic partner/civil union partner, BJC HealthSolutions groups, QBE transplant policy, Sentinel, KISx, UM/UR Vendor-specific precert requirements with group-specific alterations to those, Specialty Rx vendors language including Smith Connect 360, ScriptSourcing, Cerpass/Focus, Sharx, PaydHealth, etc., adding/revising/reformatting SOB(s)
• Revising and reformatting from reviews by Plan Build, broker, group, AE
• Auditing all source docs against each other and against SPD for consistency of plan build items, network arrangements, ERISA status, grandfathered vs. non-grandfathered compliance requirements, etc.
• Converting/combining final signature in final versions and distributing through email (this triggers placement on Sharepoint by Client Service and sending SPD to Reinsurance Carrier/MGU
• Placing on member portals
• PDM maintenance and requests/evaluations of proposed template changes for compliance/new regulations, Consociate-specific changes, and general error reviews
  
  

Amendments

• Creating/maintaining individual group's Amendment files in Account Management folder
• Maintaining tracking sheet of amendments requested/sent for review/completion.
• Creating, revising, consulting on plan amendments using the following as source docs: emails from AE/broker/Eligibility/Plan Build, SPDs, previous amendments, special language required by specific vendors for Specialty Rx, UM/UR changes, PBM changes, etc.
• Monitoring legislative/compliance changes that require plan changes across book of business (COVID, NSA, Gender-Affirming Care, removal of outdated language, etc.)
• Creating SOBs when needed for plan amendments (when group adds a plan, changes coinsurance levels, adds or subtracts a tier of coverage, or requests an updated SOB)
• Tracking approvals/requested revisions until final distribution.
• Distributing through email and placing on member portals (this triggers placement on Sharepoint by Client Service and sending to Reinsurance Carrier/MGU
  
  

HPS-Regular Portal, HPS-BJC HealthSolutions Portal, VBA/Gateway Portal

• Loading approved SBCs, SPDs, Amendments into appropriate portals, separating by appropriate divisions when needed, using correct dates for start/stop display depending on type of doc loaded.
• Annual audit for limiting historical docs shown on portals
• Maintaining h-drive Plan Docs repository files, including showing historical vs. current
• Adding/changing Employer and Broker Admin Rights, ensuring HIPPA web agreements are signed and saved.
  
  

SBCs

• Creating/maintaining group's annual SBC files in Account Management folder, which includes all SBCs in word and pdf, and their source docs.
• Maintaining/revising templates used for SBCs (separate 1, 2, 3, and 4 tier templates), including any template revisions required by Dept of HHS, CMS, DOL
• Updating standard language across templates for compliance changes, major plan design formats
• Creating/revising individual SBCs for new groups, standard annual changes, plan changes in conjunction with Amendments
  
  

PCORI

• Creating/maintaining AE's annual PCORI files in Account Management folder, which includes all reports and letters for each of their groups.
• Creating AE-specific tracking sheets for their group's PCORI rate based on group's renewal date falling before or on/after 10/1 of each successive year.
• Creating 2/each AE-specific informational letters (rate determination, filing procedure, links to govt's PCORI filing specific website updated annually) addressed to broker/group, that accompany the PCORI reporting itself, with separate letters depending on group's specific PCORI rate based on group's renewal date falling before or on/after 10/1 of each successive year.
• Running all PCORI reports from Access, reformatting to PDF, relabeling when necessary.
• Sending via email all PCORI reports and informational letters to all group and broker contacts, cc'ing AE.
• Sending via email advisory letters to all groups and broker contacts, cc'ing AE, for groups whose effective date with Consociate pre-dates the dates required for that year's PCORI fee filing.
• Responding to emails from groups and brokers who have questions about the PCORI reporting, letters, or advisory notices.
  
  

Benefit Focus

• Oversee monthly fixed cost entry, including adding/creating new Transaction Type codes and maintaining How-To-Guide.
• Monthly Data entry of Over-Spec amounts from monthly reports
• Maintaining files of monthly Sales Journal from accounting, including revised invoicing details
• Running reporting as requested
  
  

Consociate Consolidated Contact Sheet

• Maintenance of Consociate Consolidated Contact Sheet using the following as source docs: emails from AE/broker/Eligibility/Vendor Relations, Contract Specs, Implementation Guides
  
  

Other Common Tasks Requested

• Evaluation of plan design proposals on existing groups
• Interpretation of/considerations for plan document language
• Reformatting/editing word docs, converting to pdf and visa versa, editing pdf's
• Running reports from Access for specific group requests
• Maintaining files for quarterly Walmart Health Virtual utilization reporting from IT's SFTP folder
  
  

Required Experience

GENERAL EXPECTATIONS:

• Present a positive image of Consociate Health at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a client, co-worker, broker or supervisor.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Account Management Division.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees, and applicants.
• Adheres to established safety standards and utilizes proper techniques to avoid work-related injuries.
  
  

Service Expectations

• Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Ask clients what they need and strive to exceed their expectations. Offer and provide assistance whether the request falls within your specific job duties.
• Respond to client and broker requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
• Make decisions based on client needs, opinions, complaints or suggestions.
• Take appropriate steps to resolve problems to the client's or broker's satisfaction.
• Ask clients for their opinions, accepting criticism as an opportunity to improve service.
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our client.
• Remain aware of products and services provided by Consociate Health
• Project a positive, professional image when working.
  
  

Knowledge, Skills And Ability Requirements

• Associate degree in health, business or related field or comparable work experience.
• Understanding of the Insurance Industry.
• Must be articulate, possess a professional business manner and have excellent organizational and communication skills.
  
  

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid training
• Vision insurance
  
  

Keyword: Administrative Services