Plan Document Specialist

The Health Plan (THP); Wheeling (WV); On-site; USD 45,000 - 65,000; Full time

Job summary

The Health Plan in Wheeling, WV is seeking a Document Coordinator responsible for developing and maintaining Summary Plan Documents (SPD) and Evidence of Coverage for self-funded and fully insured clients. The role requires meticulous document development and regulatory compliance with ERISA standards.

You will coordinate amendments, interact with state departments via SERFF, and support pricing, audits, and compliance initiatives in a fast-paced team environment.

Qualifications

• High school diploma or GED required.
• Preferred associate degree or relevant experience in document development.
• Strong experience with Word and Adobe Acrobat.
• Excellent organization, prioritization and detail orientation.
• Ability to work independently in a fast-paced environment.
• Knowledge of ERISA and regulatory requirements in OH/WV helpful.
• Paralegal experience helpful but not required.
• Ability to work in team-oriented environments.

Responsibilities

• Develop and maintain SPD for self-funded line of business.
• Amendments and restatements to SPDs as needed.
• Interact with State Insurance Departments on form filings via SERFF.
• Develop EOC per plan code/design for fully insured line of business.
• Create and maintain Summary of Benefits and Coverage per ACA guidelines.
• Create and maintain Benefit Plan Grid for Fully Insured and MEWA.
• Prepare quarterly RX Rebate listing.
• Keep PDM updates and follow regulatory updates via PHIA webinars.
• Perform quality reviews and editing of documents.
• Provide documents to compliance for audits as needed.
• Assist in creating renewal and sale pricing proposals.
• Maintain the quoting log and contracts for ASO clients.
• Create and maintain Policies and Procedures for the department.
• Assist with external reporting.
• Support Director and SVP on special projects.

Skills

Organization

Attention to detail

Adaptability

Independent work

Teamwork

Verbal & interpersonal skills

Education

High School Diploma or GED

Associate degree or related experience

Tools

Microsoft Word

Adobe Acrobat

Job description

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.

8:00am-5:00pm

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