Benefit specialist

Benefit Specialist II or III, DOE

Remote opportunity for residents of Oregon, Washington, Idaho and Utah

Primary Job Purpose

The Benefit Development Specialist II utilizes knowledge of current and proposed healthcare regulations and potential benefit offerings to analyze, develop, implement and monitor new or existing benefits in order to ensure benefit offerings are compliant with state and federal regulations, competitive and efficient to administer.

General Functions and Outcomes

Leads ongoing benefit activities including benefit development and current benefit monitoring.

Audits and reviews complex benefit contracts and makes recommendations based on regulations and product / benefit design changes

Works with Product Development, Customer Marketing, Sales, Actuarial, Marketing Communications, Business Intelligence, and other internal departments to implement, communicate and monitor all activity affecting benefits.

Works with, and develops relationships with external associates (e.g., regulators, legislators, lobbyists, other insurers / health plans, trade associations, etc.).

Leads other specialists on benefit design aspects of research, mandates and process to further their skills.Maintains team process documentation.

Represents the department and division in cross-functional activities that impact department operations (i.e. governmental and regulatory changes).

Analyzes interdepartmental procedures and their impact on benefit structure; makes recommendations for enhancements and increased efficiencies as appropriate.

Oversees benefit change proposals and recommendations to ensure compliance with state and federal laws surrounding benefit coverage.

Tracks, reviews and analyzes regulations which can impact benefit design and presents final regulations to Product Platform Teamfor final recommendations.

Responds to inquiries from regulators regarding benefit design and compliance.

Prepares and conducts benefit presentations and training to internal and external audiences.

Oversees benefit coding configuration lists for Product Platform and process for new benefit design and ongoing code updates.

Oversees benefit design summary information creation for internal hand-off to departments for development of marketing collateral, automated customer summaries and other customer facing materials.

Oversees review of final materials for benefit accuracy sign-off.

Analyzes trends and shifts in competitive benefit offerings and communicates competitive benefit design changes and strategic implications to internal management team to help drive product development process.

Monitors regulator websites for updates related to benefit compliance and federal / state interpretations of mandates / rules.

Responds to RFP / RFI proposals for large segments of business regarding benefit information or design.

Acts as benefit expert across internal departments for ongoing benefit administration.

Leads the Medicare benefit design bid submission process to CMS for Medicare PPO line of business.Also performs and leads competitive research, benefit analysis and review of marketing collateral for benefit accuracy.

Performs and leads benefit analyses to compare benefit levels between products and assists in presentation for senior management review.

Responds to inquiries regarding specific benefits, design, and modification as well as status information and general trouble-shooting to meet the needs of the business customer.

Recommends improvements to department processes.

Acts on behalf of the Manager during his or her absence.

Conduct market research, data analysis, and benefit training.

Minimum Requirements

Demonstrated ability to organize and manage time to effectively prioritize the workload and adapt to shifting priorities.

Demonstrated ability to think analytically, apply analytical techniques, obtain benefit information from a variety of internal and external sources and provide in-depth analysis and recommendations for corrective or performance enhancing benefit strategies.

Experience in report preparation, project documentation, or policy and procedure writing, including the ability to organize and review statistical data and write concise relevant communications.

Demonstrated ability to communicate effectively with all levels of management; with tact, orally and in writing. Demonstrated writing and editing skills.

Strong presentation skills needed.

Broad knowledge of the health insurance industry, including benefit design, market demands and compliance issues.

Demonstrated ability to work effectively with all levels of staff throughout the organization.

Demonstrated ability to lead employees in working effectively within a team atmosphere to achieve department goals and objectives and thrive in a fast-paced environment.

Extensive knowledge of benefit regulations in the Cambia service area and federal level.

The Benefit Development Specialist II would have a Bachelor's degree in business, health care or related field and a minimum of five years’ experience in benefit administration, project coordination, or the equivalent combination of education and experience.

The Benefit Development Specialist III would have a Bachelor's degree in business, health care or related field and seven years’ experience in benefit administration, project coordination, or the equivalent combination of education and experience.

The expected hiring range for a Benefit Development Specialist II is $73,000 to $99,000 depending on skills, experience, education, and training;

relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10% .

The current full salary range for this role is $68,500 to $112,000.

The expected hiring range for a Benefit Development Specialist III is $80,500 to $109,500 depending on skills, experience, education, and training;

relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10% .

The current full salary range for this role is $76,000 to $123,500.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits.

In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights :

medical, dental, and vision coverage for employees and their eligible family members

annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)

paid time off varying by role and tenure in addition to 10 company holidays

up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)

one-time furniture and equipment allowance for employees working from home

up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law.

A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email .

Information about how Cambia Health Solutions collects, uses, and discloses information is available in our . As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic.

Please review the policy on our site.

Last updated : 2024-05-03