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Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.
The Plan Document Writer will support the Marketing Team with new business needs which include, but are not limited to creating medical plan documents, changes, and creating summaries of benefits and coverage (SBC’s). The schedule varies based on business needs but can be performed between the hours of 6:30 am EST to 3:00 pm EST Monday - Friday.
Primary Responsibilities:
- Evaluates and provides feedback on plan and benefit design. Participates and engages in discussion with internal and external partners related to benefit interpretation
- Research plan provisions contained in benefit plan documents including clarifying ambiguities contained in the plan language and provisions
- Provides timely documentation to users to help them reference, understand plan changes
- Maintains design specifications through documentation and revisions.
- Creating renewal business plan amendments.
- Consult with internal compliance expert and review client plan contracts, SPD’s, SMM’s to ensure compliance with Federal and State law.
- Evaluates impact of client requested exceptions and develops reasonable alternatives to satisfy client’s needs while minimizing the impact on system and operations
Qualifications:
- Undergraduate degree preferred or equivalent combination of education and experience
- Insurance industry and benefit experience preferred
- Knowledge and experience in medical, dental, disability and vision benefits preferred
- Knowledge of major medical benefit application preferred
- Knowledge and experience in medical terminology preferred
- General understanding of compliance and regulatory issues (ERISA, HIPAA, ACA, COBRA)
- Ability to communicate both verbally and in writing
- Computer proficiency in Outlook, Excel Spreadsheets, Power Point, Word Documents, and ability to learn internal systems
- Able to work in fast paced environment
- High attention to detail, excellent analytical, writing and presentation skills
- Identifies priorities and organizes time efficiently to ensure that tasks are completed to meet or exceed deadlines
- Ability to attend company, department, and team meetings as required, including industry training sessions
- Ability to travel at least 10%
- Ability to work outside of normal business hours as needed
- Relevant TPA or payer experience
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
- Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
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