Product Development Benefit Specialist- Product Development and Governance

Job Description

POSITION SUMMARY:

To be fully engaged in providing No Harm / Quality, Customer Experience, and Stewardship by: providing benefits support and benefits-related application maintenance. This position requires the ability to deal effectively with multiple complex systems and carry out support functions on projects within HFHP and across the HF enterprise as they relate to benefit alignment. Understands all aspects of the life cycle for benefits development and closings. Responsible for benefit-related functions for Product Development & Governance, Regulatory Affairs and key vendor personnel as required to meet the strategic business plans of Health First Health Plans.

PRIMARY ACCOUNTABILITIES:

• Adheres to all regulatory and certification guidelines including HIPAA, State and Federal Guidelines, and others as communicated through management.
• Facilitate data entry efforts in response to impact analysis from leadership.
• Assists and supports the implementation of process improvements, both intradepartmental and interdepartmental.
• Responsible for performance deliverables to ensure accurate, timely reporting that supports business processes.
• Responds to projects that impact health plan benefits by completing data entry of the benefit changes in the given time frames provided.
• Supports applications, associated data extracts and interfaces to align health plan benefits across all product lines, as required by project initiatives and new benefit year plan changes.
• Communicate requirements for changes to leadership to support new business processes and information systems that drive benefit outputs.
• Establishes solid working relationships with internal functional areas that enable the production of viable, cost effective administrative and system processes.
• Establishes responsible deadlines, prioritize work plans and manages time effectively.
• Perform all other duties as assigned to support leadership in general operations and on-going success of the organization while evoking creative and innovative thinking from regulatory team members.
• Provides ongoing maintenance responsibility of the operational benefit reports.

Qualifications:

QUALIFICATIONS REQUIRED:
• Bachelor's Degree preferred in health care, business administration or a related field; OR 2 year's experience in managed care or health insurance.
• PAHM certification (will be required during first year of employment).
• Knowledge of Medicare, Commercial and Individual coverage/guidelines in the HMO and PPO arena.
• Possess an understanding of Health First Health Plans product offerings.
• Knowledge of medical benefits, medical and dental terminology, and benefit plan application for Point of Service, HMO, PPO or Medicare plans.
• Must have the ability to communicate effectively and work collaboratively with others.
• Ability to understand benefit structuring in health plan applications.
• Ability to work tactfully and effectively with team members, vendor(s) and the user community.
• Highly organized, motivated, responsible self-starter, with excellent time management, analytical and problem solving skills.
• Advanced organizational skills are essential.
• Ability to prioritize work and handle multiple projects simultaneously.
• General understanding of regulatory requirements as it relates to the health plan.
• Proficiency in use of standard machines and software common to most offices, MS Word, MS Excel, MS PowerPoint and personal computing skills. Must be able to accurately type 45/50 words per minute.