Plan Document Specialist

The Health Plan of West Virginia Inc; Wheeling (WV); On-site; USD 32,000 - 42,000; Full time

Job summary

The Health Plan of West Virginia Inc. seeks a Document Coordinator for full-time clerical work in Wheeling, WV. You will develop and maintain Summary Plan Documents (SPD) and Evidence of Coverage for self-funded and fully insured clients, ensuring accuracy and regulatory compliance.

Responsibilities include amendments, SERFF filings, benefit grids, pricing support, and collaboration with compliance and sales teams. Strong attention to detail and organizational skills are essential.

Qualifications

• High School diploma or GED required.
• Associate degree or equivalent work experience preferred.
• Experience with document development and maintenance.
• Proficiency in MS Word and Adobe Acrobat.
• Strong organization, attention to detail, and prioritization.
• Ability to work independently with limited supervision.

Responsibilities

• Develop and maintain Summary Plan Documents (SPD) for self-funded clients.
• Create Amendments and Restatements when revisions are needed.
• Interact with State Insurance Departments on required product form filings through SERFF.
• Develop and maintain Evidence of Coverage for fully insured plans.
• Create and update Summary of Benefits and Coverage per ACA guidelines.
• Maintain Benefit Plan Grids for Fully Insured and MEWA.
• Prepare administrative service agreements for ASO clients.
• Assist with pricing proposals and renewal pricing as needed.
• Keep up with PDM updates and regulatory PHIA webinars.
• Perform quality reviews and edits of documents.
• Provide documents to compliance for audits as needed.
• Support special projects for the Director/SVP.

Skills

Attention to detail

Organizational skills

Verbal communication

Interpersonal skills

Independent work

Adaptability

Education

High School Diploma or GED

Associate Degree or comparable 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.

Full Time Clerical Wheeling, WV, US

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.