We're looking for… A Plan Document Specialist that will assist the team to create, maintain, update and modify the new business and renewal business plan document needs. You will help create new plan documents, plan amendments and summaries.
Who are you?
You have the ability to communicate effectively and professionally with both internal and external customers.
You are have an eye for detail and great time management skills You know how to make informed decisions using available resources and sound judgment.
You know how to identify and resolve problems promptly, gathering and analyzing information effectively and proactively.
You demonstrate accuracy and thoroughness in work, consistently monitoring for quality.
You are able to adjust to changes in the work environment, manage competing demands, and handle frequent changes, delays, or unexpected events.
What's the role?
Collaborate with the Plan Document Writer to research and amend medical plan documents, including the Summary of Benefits & Coverage (SBC), Summary Plan Description (SPD), Benefit Plan Descriptions (BPD), and Summary of Material Modifications (SMM) or Summary of Material Reduction (SMR).
Assist with incorporating new language to support legislative or administrative changes.
Oversee the inventory and status of documents from initial need through publication, including future edits.
Ensure deadlines are met.
Modify benefit design and information using templates or existing documents.
Submit completed documents or projects within Service Level Agreement (SLA) timeframes.
Work closely with internal customers to ensure the correct documentation is in place.
Investigate plan document questions using internal and external sources to validate responses and address documentation issues.
Maintain accurate data across various platforms for a range of end users.
Write procedure documentation in alignment with business goals and legal requirements.
Provide timely documentation to users to help them understand and reference how plan changes impact the system.
Publish, proofread, and edit documents to ensure ongoing compliance and quality.
Ensure data accuracy across various platforms.
Boxes to tick… Matric Bachelor's degree or equivalent work experience preferably in a healthcare or benefits TPA setting.
2+ years of experience in claims handling, quality control or plan document experience in a healthcare setting.
Familiarity with, and an understanding of the differences in, each type of Plan Document: SBC, SPD, BPD, SMM, and SMR.
Knowledge of medical procedure terminology preferred.
You can maintain confidentiality and exercise discretion in handling sensitive information.
You are proficient in Microsoft Office Working Hours: 2pm - 11pm