Plan Document Specialist

The Health Plan Of West Virginia Inc; Wheeling (WV); On-site; USD 38,000 - 54,000; Full time

Job summary

The Health Plan Of West Virginia Inc. is seeking a Document Coordinator in Wheeling, WV to develop and maintain Summary Plan Documents (SPD) and Evidence of Coverage for self-funded and fully insured clients. The role requires precise document handling and strong organizational skills.

Responsibilities include amendments, state filings, ACA SBC maintenance, and collaboration with compliance for audits. A high school diploma is required, with preferred associate degree or related experience in

Qualifications

• High School Diploma or GED required.
• Associate Degree or comparable work experience with document development and maintenance preferred.
• Strong experience in Word and Acrobat.
• Willingness to learn additional programs as needed.
• Excellent organization and prioritization skills.
• High attention to detail.
• Ability to work in a high paced environment.
• Adapts easily to changes in processes.
• Strong verbal and interpersonal skills.
• Ability to work independently with limited supervision.
• Knowledge of ERISA and regulatory requirements helpful.
• Paralegal experience appreciated but not required.
• Ability to work in various team oriented situations.

Responsibilities

• SPD development and maintenance for self-funded line of business.
• Amendments and Restatements for SPDs.
• Interact with State Insurance Departments on product form filings via SERFF.
• Evidence of Coverage development and maintenance for fully insured line.
• SBC creation and maintenance per ACA guidelines for Fully Insured and MEWA.
• Benefit Plan Grid creation and maintenance for Fully Insured and MEWA.
• Create and execute all Administrative Service Agreements for ASO Clients.
• Prepare the quarterly RX Rebate listing.
• Keep up with PDM updates as needed.
• Regulatory updates with PHIA webinars.
• Quality reviews and editing of documents.
• Provide documents to compliance for audits as needed.
• Assist in creating sale pricing proposals and renewal pricing proposals.
• Maintain the quoting log and contracts for ASO clients.
• Assist in creating and maintaining Policy and Procedures for the department.
• Assist with external reporting process.
• Support the Director of Implementation and SVP in special projects.

Skills

Organization

Prioritization

Attention to detail

Adaptability

Communication

Independence

Teamwork

Paralegal experience

Willingness to learn

Regulatory knowledge

Education

High School Diploma or GED

Associate Degree or equivalent work experience

Tools

Microsoft Word

Adobe Acrobat

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Sales & Account Mgt SF-Comm Full Time Clerical Wheeling, WV, US

30+ days ago Requisition ID: 1613

Under the direction of the Director, Implementation & Eligibility, Document Coordinator is to develop and maintain all Summary Plan Documents (SPD) for all Self Funded clients and Evidence of Coverage as well as other documents for the Fully Insured clients.

QUALIFICATIONS:

• High School Diploma or GED required.
• Preferred Associate Degree or comparable work experience with document development and maintenance.
• Strong experience in software programs: Microsoft Word, Adobe Acrobat.
• Willingness to learn additional programs as needed.
• Excellent organization and prioritization skills.
• High level of attention to detail.
• Ability to work in a high paced environment.
• Easily adapts to changes in work processes.
• Strong verbal and interpersonal skills.
• Ability to work independently and with limited supervision.
• Active knowledge of industry (ERISA) and regulatory requirements in Ohio and West Virginia helpful.
• Paralegal experience helpful, but not required.
• Ability to work in various team oriented situations.

ESSENTIAL FUNCTIONS AND RESPONSBILITIES:

• Summary Plan Document (SPD) development and maintenance for self-funded line of business.
• Amendments and Restatements when changes or revisions need made to SPDs.
• Interact with State Insurance Departments on required product form filings through SERFF.
• Evidence of Coverage development per plan code/design and maintenance for fully insured line of business..
• Summary of Benefits and Coverage creation and maintenance per the ACA guidelines, Fully Insured and MEWA.
• Benefit Plan Grid creation and maintenance for both Fully Insured and MEWA.
• Create and execute all Administrative Service Agreements for ASO Clients.
• Prepare the quarterly RX Rebate listing.
• Keeping up with PDM updates as needed.
• Regulatory updates with PHIA webinars.
• Perform quality reviews and editing of documents.
• Provide any documents to compliance for audits, as needed.
• Assist in creating any new sale pricing proposals.
• Assist in creating renewal pricing proposals.
• Assist in maintaining the quoting log.
• Assist to maintain icontracts for ASO clients.
• Assist to creating and maintaining Policy and Procedures for the department.
• Assist with the external reporting process.
• Assist Director of Implementation and/or SVP of Sales and Account Management in special projects.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.