Benefit Contract Compliance Analyst
Cambia Health Solutions

Portland, Oregon

Posted in Health and Safety


This job has expired.

Job Info


Benefit Contract Compliance AnalystPortland, OR

The Benefit Contract Compliance Analyst will assist the Benefit Contracts & Compliance (BCC) team in the development of contracts and related materials by analyzing and reviewing such documents for compliance with state and federal laws and regulations. Create and maintain policies and procedures related to the responsibilities and functions of the position. Provide support to the Regulatory Affairs division by analyzing proposed new statutes, regulations and legislation to assess their impact on contracts and related materials as well as direct the implementation of such changes to contracts and related materials. This position may provide support for multiple Cambia affiliate states.

This position requires extensive interaction with all company departments, as well as external persons (e.g., regulators, legislators, lobbyists, group administrators, other insurers/health plans, trade associations, brokers, etc.) and it is essential that the incumbent be able to take all appropriate actions to build and maintain trust relationships with such persons.

Responsibilities:

  • Assist with activities specific to establishing and maintaining accurate contract and benefit language information for use in legal contracts, benefit summaries and benefit booklets.
  • Represent the Corporation and interact with all company departments, as well as external persons (e.g., regulators, legislators, lobbyists, group administrators, other insurers/health plans, trade associations, brokers, etc.) and take all appropriate actions to build and maintain trust relationships with such persons.
  • Perform proactive compliance review of member contract/booklets, applications, and all other forms required to be filed with state regulators. This includes the examination of member contracts/booklets for underwritten lines of business to assess compliance with federal and state law while meeting the product needs of the Corporation.
  • Obtain regulatory approval for all member contract/booklets, applications, and all other forms required to be filed with state regulators in which Regence is licensed.
  • Review procedures for regulatory filing and maintenance, which includes interaction and negotiation with the Insurance Department, maintain regulatory compliant files to ensure proper documentation is retained for market conduct studies and other business needs.
  • Serve as a resource to other divisions to confirm that Corporate documents comply with state code and regulation requirements prior to submission to the Insurance Department.
  • Assist with the negotiation of contractual language of Administrative Service Only ("ASO") Plan Documents and ASO funding agreements, so that they are compliant with federal law and reflective of the plan design developed in consultation with the group and outside agent. Serve as resource for development of language for ASO funding agreements, contracts, plan documents and other related legal documents to ensure regulatory compliance efforts.
  • Work with other divisions to evaluate and support the development of new products and/or modification of existing products to remain constant with current business and market needs and allow for continuous efficient service to be provided to all internal and external clients. This includes participation in product development by researching state and/or federal requirements and informing the product development committee of required/allowed provisions.
  • Support for on-line communications regarding contract contents for use by other divisions.
  • Access and navigate the electronic publishing system used for creation of member contracts/booklets/plan documents/summary plan descriptions, including the ability to manually override system defaults necessary to accurately complete such documents and identify system issues prohibiting document completion, escalating issues to the Lead and/or Information Technology division, as appropriate.
  • Establish and maintain a solid working relationship with the Insurance Department to facilitate regulatory compliant forms filings.
  • Act as resource for the interpretation of contracts/booklets and plan documents/summary plan descriptions for all divisions of the corporation and follow-through to ensure proper administration of such document.
  • Responsible for tracking, reviewing and analyzing regulatory proposals, including new statutes and regulations and interpreting the impact of proposed legislation which could impact contractual language in order to identify and recommend necessary language changes to contracts.
  • Communicates Company policies and procedures regarding implementation and technical compliance of contracts.
  • Creates and monitors project work plans to ensure that tasks are identified, executed, and timelines are met.
  • Support the Manager/Supervisor in enforcing policies, procedures, work rules and performance standards to ensure the efficient and effective day-to-day operations of the team.
  • Develop and maintain systems and records that provide for proper reporting, evaluation, control and documentation of workload.
  • Establish guidelines and materials and identify procedures and systems requiring quality or process improvement and design and implement such revisions.
  • Participate as a BCC and Cambia organization representative in committee meetings and workgroups required to determine requirements, define project deliverables, inform work plans and educational materials, operationalize contract requirements, provide compliance feedback and status reports, and offer alternative solutions, if necessary.
Minimum Requirements:
  • General knowledge of BCC functions, as follows:
  • Administration of member contracts/booklets for underwritten lines of business which includes member contracts and ancillary benefit plans to ensure compliance with federal and state law and meet the product needs of the Corporation as well as conform with Corporate (e.g., medical policy, product development) and legislative changes, and interpreting of contract provisions for all levels of staff within the Corporation to ensure proper enforcement.
  • Administration of Administrative Service Only ("ASO") contracts for self-funded lines of business which includes negotiation of ASO funding agreements, plan documents and summary plan descriptions that are compliant with federal law and reflective of the plan design developed in consultation with the group and outside agent as well as conform with mandatory and requested changes (e.g., medical policy, legislation, plan administrator or plan sponsor requirements, etc.), and interpreting of contract provisions for all levels of staff within the Corporation to ensure proper enforcement.
  • Regulatory filing and maintenance which includes providing support to outside departments to help confirm that Corporate documents as well as all documents created by BCC comply with federal and state laws as well as state insurance code requirements prior to submission, file forms with the Insurance Department using either the established manual protocol or the electronic database subscribed to by the Corporation, maintain regulatory compliant files to ensure proper documentation is retained for market conduct studies and other business needs, and create and maintain a register of approved forms.
  • Demonstrated understanding of healthcare industry and politically affected areas with emphasis on state and federal health care laws and regulations.
  • Demonstrated leadership and team building skills.
  • Demonstrated creative thinking and effective strategic planning and facilitation abilities.
  • Demonstrated superior decision-making abilities under a variety of circumstances.
  • Excellent verbal communication skills. Knowledge of interpersonal communication methodologies.
  • Knowledge of project management and organizational techniques and methods.
  • Knowledge of legislative and regulatory processes.
  • Command of all aspects of the health insurance industry, including benefit design, market demands and compliance issues and be capable of incorporating into contracts and other related printed materials.
  • Strong organizational skills with a demonstrated ability to prioritize and develop multiple projects within varied time constraints.
  • As available, advanced technical skills necessary to effectively navigate the electronic publishing system used for document creation.
  • Ability to coordinate activities and work professionally with all levels of staff within the plan and geographically located counterparts, in addition to external agencies through clear and concise communication.
  • Ability to analyze, evaluate and implement health care public policy and regulatory proposals.
  • Ability to prioritize and analyze diverse opinions regarding interpretation of laws, regulations and standards to assure proper implementation.
  • Advanced knowledge of federal laws and guidelines (including but not limited to COBRA, HIPAA, ERISA, USERRA, DOL. etc.) and applicable state insurance code and regulations.
  • Ability to work in high-pressure circumstances on multidisciplinary, unconnected tasks and produce detailed work during periods of high-volume demands.
  • Working knowledge of Microsoft Office products.
  • Ability to navigate the English language, analyze and review written materials and verbal communications and manipulate them in such a manner as to communicate complex ideas in concise and relevant written communication material.
Normally to be proficient in the competencies listed above:

Bachelor's degree in business, health care administration, public policy, social science or related field and 6-8 years of work-related experience or equivalent combination of education and work experience and general knowledge of BCC functions. Juris Doctorate (JD) preferred.

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 drug screen and background check are required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.


This job has expired.

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