PacificSource Health Plans

  • Commercial Contract Specialist

    Job Location US-OR-Springfield
    Job ID
    2018-302B
    Type
    Regular Full-Time
    Hiring Pay Range
    $21.60 - $24.50 an hour
    # of Openings
    1
    Status
    Non-Exempt
  • Overview

    Participate in processes for developing new and revised insurance contracts, policies, and related documents for commercial product offerings. Responsible for state form filings and QHP plan certification binder filings. Act as primary liaison between PacificSource and state insurance divisions. Assist with implementation of standard and negotiated insurance contracts and related forms.

    Responsibilities

    1. Participate in committees and work groups to create, develop, review and implement new or revised health insurance contracts, policies, and related documents.
    2. Participate in the coordination of internal review of new and revised documents.
    3. Review health insurance contracts, policies, and related documents to ensure compliance with existing state and federal law and regulations.
    4. Coordinate, prepare, and submit health insurance contracts, policies, and related documents to the respective state regulators.
    5. Coordinate form and binder filing objections, from respective state regulators, with internal departments and submit responses within the required timeline.
    6. Collaborate with internal departments to collect and submit templates along with supporting documentation for filing Qualified Health Plan binder filings to the respective regulatory authorities.
    7. Assist other departments with the implementation of health insurance contracts, policies, and related documents.
    8. Maintain records of contracts, policies, and related documents filed with the respective state regulators.
    9. Participate in the review of negotiated contracts, policies, and related documents that do not require filing with respective state regulators.
    10. Coordinate activities with internal departments to ensure proper and timely filing of contracts, policies, and related documents to ensure timely approval for all commercial products.
    11. Participate in reviewing interpretation of contract and policy language with related insurance regulations language.
    12. Participate in committees or projects when knowledge, skills, and experience may be useful to the committee’s purpose.
    13. Create policies and procedures, job aids and other appropriate documentation to perform essential job functions.

    Supporting Responsibilities:

    1. Provide assistance to Management and other internal departments as required for efficient functioning of the department.
    2. Meet department and company performance and attendance expectations.
    3. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    4. Perform other duties as assigned.

    Qualifications

    Work Experience: Two years of health insurance experience required.

     

    Education, Certificates, Licenses: BA degree in business or a related field is preferred or equivalent work experience.

     

    Knowledge: General knowledge of state and federal health insurance law and regulations. Ability to gain a thorough understanding of PacificSource products, insurance contracts, and related materials. Strong research, analysis, organizational, communication (written and verbal), and interpretative skills. Working knowledge of medical terminology. Ability to read and understand health contract and benefits language. Ability to work under time pressures. Excellent written and oral communication skills. Ability to clearly communicate with coworkers and to accurately interpret complex contract language. Ability to prioritize responsibilities and to diplomatically handle difficult situations.

     

     

    Competencies

    Our Values

    • Adaptability
    • Building Customer Loyalty
    • Building Strategic Work Relationships
    • Building Trust
    • Continuous Improvement
    • Contributing to Team Success
    • Planning and Organizing
    • Work Standards

     

     

    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers’ experience.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our many communities-internally and externally.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

     

    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

     

    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

     

    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

     

    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

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