Responsible for the drafting, review and maintenance of new and existing group agreements and addendums for new account sales and existing account renewals. Works in tandem with Sales and Marketing, Underwriting, and internal and external legal Counsel to ensure new group agreements are accurate and meet regulatory requirements. The Coordinator audits and identifies groups requiring group agreements. The position is responsible for the interpretation of legislative mandates and identification of impact on group agreement templates and addendums. Ensures actions and documents are in compliance with Federal and New York State Insurance (NYSI) regulations.
• Analyzes requests for new benefits, new products, mandates and account specific changes to determine impact to existing legal documents (member or group). Requires identification of all existing legal documents that may be impacted.
• In conjunction with Attorneys, responds to regulatory inquiries within designated timeframes.
• Provides sales support by providing target dates, forms, impacts & guidance of contract process. May initiates the contract process by contacting appropriate sales consultant or account service representative whenever necessary.
• Maintains accurate records on all designated systems following established policies (Seibel, Contract Development System, Membership systems).
• Demonstrates adherence to all internal controls, all regulatory requirements and provides explanation, as required.
• Creates new metric reporting as needed for management to support tracking of legal document activity.
• Works with team members to create process improvements, supporting documentation and complete final implementation.
• Functions as division/company representative on assigned corporate teams involving project implementations and/or evaluation of company practices.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
• Creates group agreements and other legally binding documents containing the group demographics, product rates, financial arrangement, renewal dates and member legal documents.
• Obtains rates and Underwriting review of legal documents to ensure group type, product descriptions, financial arrangement and product rates are accurate.
• Analyzes benefit and rate information on group support systems (Seibel, Stepwise or membership systems) for all new and renewing groups to initiate the group agreement process. Includes creation & execution of Step Wise & Seibel reports to identify new & renewing groups.
• Collaborates with and coordinates, as necessary, legal support for custom group agreements and participates in all Corporate Legal/Sales/Client meetings to ensure understanding of commitments.
Level II - performs all functions of Level I in addition:
• Effectively navigates & trains the process required to analyze all benefit and rate information on group support systems (e.g. Contract Development System, Seibel, Stepwise or membership systems). Includes the creation & execution of system reports.
• Provides training and guidance to Contract Development staff as needed.
• Analyzes & creates group structure and legal document charts to support issuance and printing of same.
• Identifies changes and works in conjunction with Attorneys to revise legal document templates.
• Acts in a consultative capacity to staff of all levels to provide professional technical expertise in determination of suitable approaches to creation, regulatory submission and implementation of legal documents.
• Identifies & leads projects to implement approved process improvements. Prepares & delivers necessary written & oral presentations.
• Creates complex group agreements, negotiates (on content) for group agreements and other legally binding documents. Includes demonstrated proficiency to define financial mechanisms, select the correct document template and create Premium Schedules appropriate to group structures.
• Engages Corporate Legal support as required to create custom group agreements.
• Researches and drafts responses to external account inquiries on group agreements. Determines need and seeks Attorney review when appropriate.
• Works in partnership with underwriting staff to validate and ensure financial arrangement descriptions and product rates are accurate for complex & negotiated groups.
• Engages Sales to fully participate in the group agreement process by working in partnership to set target dates, obtain forms and execute agreements.
• Bachelor's degree in Business Administration, Communications or related field with a minimum of three years’ experience in the health care industry. In lieu of degree, a minimum of eight years’ experience working on contract agreements in the health care industry.
• Demonstrated understanding of Health Plan group financial arrangements and member contracts and riders.
• Familiarity with State & Federal legislative mandates, laws and revisions.
• Capable of establishing constructive relationships with internal and external staff and management of all levels. Includes ability to maintain professionalism and poise under pressure and strategize with management staff and Attorneys.
• Excellent written communication skills including a minimum of 2 years technical or business writing experience.
• Strong analytical ability and project management skills.
• Ability to prioritize assignments, work independently and handle confidential information with discretion is essential.
• Experienced system knowledge including LRSP, Facets, Mabil, Seibel, StepWise and Lotus Notes.
• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, PowerPoint and Access).
Level II - In addition to Level I qualifications:
• Demonstrated knowledge of Federal & NYS regulatory requirements including the ability to utilize on-line Federal & NYS web sites.
• Minimum of three years of progressive group agreement document development demonstrating expertise & proficiency in drafting & execution of both standard & complex group agreements, negotiated group agreements and other legally binding documents.
• Proven capability of establishing constructive relationships with internal & external staff and management at all levels.
• Demonstrated proficiency with corporate systems supporting legal document data.
• Maintains thorough knowledge of all products, benefit interpretations and available financial arrangements.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Excellus BlueCross BlueShield - 17 months ago