Relation Insurance Services · 8 hours ago
Health Plan Compliance Specialist
United States
Full-time
Remote
Entry, Mid Level
2+ years expRelation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. The Health Plan Compliance Specialist is responsible for the creation, maintenance, and delivery of compliant health plan documentation, ensuring all materials meet regulatory requirements and align with client benefit designs.
ConsultingEmployee BenefitsFinancial ServicesInsuranceRetirement
Responsibilities
Creates, maintains, and updates PHIA-regulated Summary Plan Descriptions (SPDs) and Plan Documents for ERISA and non-ERISA health plans, ensuring compliance with all applicable regulations
Produces Summaries of Benefits and Coverage (SBCs) in accordance with federal and state compliance requirements and ensure alignment with unique client plan design
Manages plan renewals and drafts plan amendments, ensuring accuracy, consistency, and timely delivery across a high-volume document environment
Supports the production and delivery of 80+ plan documents per month, adhering to established timelines and quality standards
Participates in client implementation meetings to review benefit outlines, clarify plan requirements, and gather all necessary information prior to document creation
Collaborates with cross-functional teams (e.g., implementation, compliance, operations) to ensure plan materials are aligned, compliant, and reflective of client expectations
Collaborates with the member services team leads to ensure accurate information needed to allow that team to effectively respond to member inquiries and resolve benefit-related questions
Serves as a liaison with Edison Health Solutions’ compliance vendors to ensure regulatory updates, template changes, and mandated federal guidelines align with contracts, benefit designs, and are incorporated into all health plan materials
Conducts quality reviews to confirm plan documents accurately reflect approved benefit designs and regulatory requirements
Maintains organized documentation records and version control in accordance with internal procedures and compliance standards
Assist with regulatory audits, client compliance inquiries and review related to the plan document
Coordinate with vendors to support required federal and state health plan filings, including but not limited to Gag Clause Prohibition Compliance (GCPCA), RxDC reporting, NY HCRA reporting, and other regulatory compliance submissions applicable to self-funded health plans
Conduct the preparation, validation and submission of data and documentation for mandated filings listed above
Maintain compliance calendars, filing records and documentation needed to support audits, client inquiries and regulatory reviews
Performs other projects, duties, and tasks, as assigned
Qualification
Required
High School diploma or equivalent
Strong writing, editing, and proofreading skills with attention to detail
Strong knowledge of employee benefits and health plan concepts (medical, Rx, dental, vision, HSA/HRA/FSA)
Working knowledge of the laws and regulations associated with HIPAA
Strong knowledge of health plan design & terminology
Willingness to adhere to all principles of confidentiality
Proficiency with Microsoft Word (templates/styles), Excel, and Adobe Acrobat
Ability to manage multiple deadlines in a fast-paced, high-volume environment
Ability to work independently and follow through on deliverables
Excellent communication and collaboration skills
Proficiency with Microsoft Office (Word styles/templates, Excel), Adobe Acrobat, and redlining tools
Preferred
Bachelor's degree in Business, Health Administration, Public Policy, English, or related field; equivalent experience preferred
2+ years of experience working for a Third Party Administrator, health insurance broker, carrier, or benefits consulting firm in a role involving benefit plans, client implementation, compliance, or plan document preparation preferred
Familiarity with plan document generation platforms or template libraries preferred
Exposure to ERISA, ACA, HIPAA, COBRA, MHPAEA, and state benefit mandates preferred
Familiarity with SBC templates and plan document generation platforms preferred
A Life Accident and Health License from state of domicile is preferred
Benefits
Family health and wellness programs
401K
Employee assistance programs
Paid time off
Paid holidays
Company
Relation Insurance Services
Despite our size, Relation feels like a family company. Here, a handshake matters.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2019-02-21Acquired
Leadership Team
Charissa Hartmann
Chief Financial Officer
Douglas Turk
President, Specialty
Recent News
Mergers & Acquisitions
2025-11-11
2025-08-29
2025-08-26
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