Contracts Specialist (Paralegal)

Overview

A senior contract specialist role is available requiring over 5 years of contract management experience, with recent experience in healthcare contract management. The position involves reviewing, editing, and comparing contracts, particularly those related to evidence of coverage.

Responsibilities

• Review and draft group and individual contracts and certificates for risk and self-insured accounts, including indemnity and HMO contracts.
• File all forms with appropriate Insurance Administrations and regulatory agencies to ensure legal compliance.
• Respond to inquiries from Insurance Administrations, Central Appeals Unit, Executive Inquiry, Corporate Audit, and other departments.
• Consult with Legal, Government Affairs, and other departments as necessary.
• Research local and federal codes and regulations relevant to contracts.
• Produce production forms, maintain implementation documentation, and provide detailed implementation instructions.
• Audit contracts and special documents for accuracy and resolve issues with relevant departments.
• Participate in company initiatives, operations meetings, legislative review committees, and team implementation meetings.
• Monitor contract performance for compliance with terms, legal requirements, customer specifications, laws, and regulations.
• Interpret benefit issues and provide contract interpretations, resolving complex issues with Legal and Health Care Policy staff.
• Review, interpret, and respond to account-specific RFPs, RFIs, and other requests; draft and file group account-specific contracts and certificate language.
• Produce and implement account-specific production forms for customized benefits.
• Review corporate communications, promotional literature, internal documents, ecommerce documents, and training materials to ensure contract integrity.
• Analyze proposed product designs and changes, providing input to work groups, Marketing, and Product Development.

Requirements

• Minimum 5 years of contract management experience.
• Recent healthcare contract management experience.
• Strong communication and writing skills.
• Bachelor's degree preferred; in lieu of a degree, an additional 4 years of relevant work experience is required.
• Experience in health insurance benefit/product knowledge, benefits delivery systems, or contract management.

Preferred Qualifications

• Ability to perform essential duties satisfactorily with reasonable accommodations if needed.

Location

Not specified.

Compensation & Benefits

Not specified.