Commercial Contract Specialist

PacificSource Health Plans; Portland (OR); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

401(k)

Paid maternity leave

Tuition assistance

Job summary

A health insurance provider is seeking a Commercial Contract Specialist in Portland, Oregon. The role involves managing regulatory filings and ensuring compliance with state and federal requirements. The ideal candidate will have at least three years of experience in health insurance and strong attention to detail. This full-time position offers a salary range of $60,000.00-$75,000.00.

Qualifications

• Minimum of three years of health insurance experience required.
• Experience with regulatory entities and SERFF filings required.
• Ability to interpret complex contract language.

Responsibilities

• Responsible for accuracy and development of regulatory documents.
• Coordinate review of new and revised commercial regulatory documents.
• Lead discussions with operational areas for filing objections.

Skills

Health insurance experience

Regulatory compliance

Strong communication skills

Attention to detail

Microsoft Office skills

Education

High School diploma

Bachelor’s degree in business or related field

Job description

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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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Responsible for the development and accuracy for all commercial regulatory filed forms. This position requires independent judgement and decision making aptitude in the coordination and submission of Qualified Health Plan (QHP) binder filings submitted through NAIC System for Electronic Rates and Forms Filing (SERFF) by required deadlines. Role is a primary liaison between PacificSource and CMS and state insurance divisions in Oregon, Idaho, Montana for commercial filed documents.

• Responsible for the accuracy, creation and development of commercial regulatory documents
• Coordinate, as the subject matter expert, and must demonstrate independent judgement on the internal review and decisions of new and revised commercial regulatory documents to achieve filing approvals
• Prepare state and federally accurate and compliant forms, submit all commercial required documents to respective state and/or federal regulators by established regulatory submissions due dates.
• Responsible for the coordination, preparation and filing of all Association and client specific documents as required by the state. Must be able facilitate correspondence and must possess the specialized skillset to ensure filing approvals
• Lead cross functional team meetings throughout the filing process to ensure regulatory inquires meet state required timelines.
• Lead and facilitate discussions with operational areas in the company for form and binder filing objections received from state regulators. Must possess operations knowledge to script and submit responses within required timelines and to achieve filing approvals
• Collaborate with internal departments to ensure benchmark requirements are met, collect and submit templates and supporting documentation required for QHP binder filings
• Ensure a working collaborative relationship with state regulators to aid in filing and objection process to ensure filing approvals
• Serve as a subject matter expert in providing direction to internal departments with the implementation of approved health insurance contracts, policies, and related documents.
• Maintain records of required regulatory documents filed with the respective federal and state agencies.
• Document and maintain records throughout the year of issues that are identified that will require revisions for the following filing
• Participate and provide direction in the review of negotiated documents that do not require state regulatory filing.
• Review policy and procedures with all operational areas to ensure administration and processes are consistent with approved filed language.
• Actively participate as a key team member in department meetings.
• Collaborate and create policies and procedures, job aids and other appropriate documentation to perform essential job functions.
• Assist Business Analysts, as needed. Review benefit summaries, negotiated language for materials and forms, and other materials as created/altered

Supporting Responsibilities

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

SUCCESS PROFILE

Work Experience: Minimum of three years of health insurance experience working with regulatory entities and SERFF filings required

Education, Certificates, Licenses: High School diploma or equivalent required. Bachelor’s degree in business or a related field is preferred.

Knowledge: Strong proficiency with interpretation of state and federal health insurance rules and regulations. Must possess a comprehensive understanding of PacificSource products, all filed commercial documents operations, and related materials. Strong research, analysis, organizational, and interpretative skills to provide direction and decisions to operational areas. Ability to research and understand state and federal regulatory requirements for filing documents. Ability to work under time constraints. Excellent written and oral communication skills. Strong attention to detail is critical. Ability to interpret complex contract language and clearly communicate with coworkers. Ability to prioritize responsibilities and diplomatically handle difficult situations. Strong Microsoft Offce skills.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Administrative

• Industries

  Insurance

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Paid maternity leave

Tuition assistance

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