Senior Contract Specialist (Paralegal)

Overview

A senior-level Contract Specialist position is available to support Benefit Contract Management (BCM) by ensuring contract form compliance, recommending improvements, and managing contract-related processes. This role involves collaboration with Legal, Government Affairs, Product, Marketing, Health Services, and Strategy teams to align contract management with organizational goals.

Responsibilities

• Draft group and individual indemnity and HMO contracts and certificates for risk and self-insured accounts.
• File all forms with 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 applicable local and federal codes and regulations.
• Produce production forms, maintain implementation documentation, and provide detailed 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.
• Audit account installation master documents and procedures for compliance.
• Monitor contract performance for conformance to 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; write and file group account-specific contracts and certificate language with regulators.
• Produce and implement account-specific production forms for customized benefits.
• Review corporate communications, promotional literature, internal documents, e-commerce documents, and training materials to ensure contract integrity.
• Analyze proposed product designs and changes, providing input to work groups, Marketing, and Product Development.

Requirements

• Bachelor's Degree.
• Minimum of 5 years of experience in health insurance benefit/product knowledge, benefits delivery systems, or contract management.
• At least 5 years of contract management experience.
• Recent healthcare contract management experience.
• Strong communication and writing skills.
• Experience reviewing and editing contracts, including comparing multiple contracts.
• Familiarity with contracts related to evidence of coverage.

Location

Details regarding the work location were not specified.