MagnaCare · 4 days ago

Senior Benefits Analyst

United States

Full-time

Remote

Senior Level

5+ years exp

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Health Care

Hiring Manager

Paul Pascale

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Responsibilities

Review and interpret all clients plan documents, amendments, notices and summary plan descriptions to ensure that clients Self Insured Health Plans is administered accurately.

Interpret and translate all clients benefit documentation into an internal source document and work with IT and Operations to ensure claims are properly coded into the claims system.

Interface directly with clients to ensure proper interpretation of all benefits and plan rules, as well as ensure internal claims system is correctly adjudicating claims.

Collaborate with various departments to assist with interpretation of clients' medical benefit plans, to ensure the correct information is being disseminated to team members, providers, and clients; claims are processing correctly; any necessary changes are being modified and programmed into the claims processing system.

Assist in reviewing clients Summary Plan Description based on clients' current plan design(s), ensuring that the SPD correctly reflects current benefits set up and claims administration.

Review clients benefit plans for compliance with all ERISA and PPACA guidelines. Provide recommended plan changes, as needed, and work independently with Medical Management and Legal Departments on policies and client communications.

Assist in preparing, tracking, and maintaining all clients associated benefit documentation including but not limited to, summary plan descriptions (SPD), summary of benefit comparisons (SBC), summary of material modifications (SMM) and benefit summaries.

Staying informed related to all changes to ERISA health benefits regulations and keeping clients and internal partners up to date.

Providing creative, innovative and strategic expertise to clients and colleagues around the issues and emerging developments in the employee health benefits.

Review clients ERISA medical benefit plans and make meaningful cost savings plan change recommendations.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

ERISA benefit regulationsSelf-insured benefitsClaims processingSelf-insured claims experienceSummary Plan Description (SPD)Benefit plan complianceProject managementMedical codingCEBS certificationGBA certificationUnion experience