Plan Documents Specialist

We exist for workers and their employers -- who are the backbone of our economy.  That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

Centivo is hiring Plan Documents Specialists (Jr and Sr)! Under the guidance of the Plan Documents Manager, the Plan Documents Specialist will work cross-functionally with the Configuration, Implementation, Client Success, and Product teams to ensure best-in-class output, client experience, and satisfaction, which can include regular interaction with brokers, agents, TPAs, stop loss carriers, and other applicable vendors and clients.

The Plan Documents Specialist is a key member of the delivery team, facilitating client onboarding for document preparation, client changes, document management, and other duties related to requirements for employer-sponsored welfare benefit plans under the following federal and employment laws:

• Employee Retirement Income Security Act (ERISA)

• Internal Revenue Code (Code)

• Health Insurance Patient Portability and Accountability Act (HIPAA)

• Medicare Secondary Payer Act (MSP)

• Consolidated Omnibus Budget Reconciliation Act (COBRA)

• Affordable Care Act (ACA)

• Women’s Health and Cancer Rights Act (WHCRA)

Junior Responsibilities Include:

• Assisting in client implementation and client plan changes, defining clients’ benefits and structure for document preparation/completion for required plan document creation.

• Managing benefit plan documentation processes including:

  Conducting and managing a complete, section-by-section review of prospective conversion plan documents, including, but not limited to, Summary of Material Modification (SMM), plan amendments, and Summary of Benefits and Coverage (SBC)

  Conducting and managing a complete, section-by-section review of prospective conversion plan documents for a Summary Plan Description (SPD) with some feedback/assistance from Senior team member(s) and/or Plan Documents Manager, if needed

  Drafting, finalizing, and maintenance of standard benefit plan documents (i.e. SBCs, standard to intermediate level plan amendments) by identifying/understanding change requests and their requirements. Must have the ability to identify more complex tasks and request assistance from Senior team member(s) and/or Plan Documents Manager when needed.

  Drafting standard SPDs (or those that require minimal customization) with some assistance from Senior team member(s) and/or Plan Documents Manager. Must have the ability to work with and take instruction from Senior team member(s) and/or Plan Documents Manager in order to complete SPDs that may become more involved during process.

  Identifying missing items needed for document preparation

  Submitting finalized plan documents and any changes to stop loss carriers or Stop Loss team as well as PDM vendor.

  Determining changes to plan documents to ensure accuracy, seamless coverage, and any additional updates as necessary.

• Managing and maintaining a book of business primarily relating to Mid-Market accounts and/or assigned projects at direction of Plan Documents Manager

• Stay current on requirements under ERISA, PPACA, and other related laws/regulations as it relates to plan benefits.

• Elevating client issues and concerns to appropriate to leadership and or Client Success team members when necessary.

• May assist in training process of Analyst and newly hired Junior team members at the direction of Plan Documents Manager.

• May support client communications, including, but not limited to, introductory calls with assistance/feedback from Senior team member(s) and/or Plan Documents Manager.

• Performing other miscellaneous projects, assignments, and duties as assigned

Senior Additional Responsibilities Include:

• Verifying eligibility status and requirements for the plan to be included in the documents

• Drafting, finalizing, and maintenance of non-standard or moderate to complex benefit plan documents (i.e. SBCs, SPDs, SMMs) by identifying/understanding change requests and their requirements with little to no assistance from Plan Documents Manager.

• Supporting client communications, including, but not limited to, introductory calls

• Assisting Junior members with more complex drafting requests.

• Managing and maintaining a book of business relating to Mid-Market accounts, Enterprise, or Strategic accounts, but not limited to, and/or assigned projects at direction of the Plan Documents Manager.

• Assisting with client/internal departments on inquiries such as those escalated due to SBC and SPD language concerns, compliance issues, or customization requests with assistance from Plan Documents Manager when needed.

• May assist with PDM vendor contact, including discussions pertaining to federal/state mandates, governmental changes, or customized requests, along with Plan Documents Manager.

• Assist in training process of Analyst, Junior, or newly hired Senior members at direction of Plan Documents Manager.

Qualifications:

Required Skills and Abilities:

• Strong organizational and multi-tasking skills, attention to detail

• Excellent written, verbal, and interpersonal communication skills; including ability to identify and communicate clearly on inconsistencies and issues found during drafting process

• Ability to manage time effectively, set priorities effectively and meet deadlines

• Intermediate to advanced knowledge of Microsoft Office products (Excel, Power Point, Word)

• Demonstrated ability to meet performance goals, including accuracy and productivity

• Ability to take initiative and be self-motivated while exercising proactivity and creativity in problem solving and appropriate decision-making

• Display, at minimum, an intermediate level of understanding for compliance principles as it applies to document drafting and client communication

• Team player and willingness to take instruction when necessary

• Must be able to adapt, be flexible, and have the ability to function efficiently during fast-paced work environment

• Have passion and drive in delivering quality documents

• Ability to work independently with minimal supervision

• Typing speed of at least 60-70 WPM

Junior Education and Experience:

• 1-3 years of employee benefits paralegal or similar job experience required

• 1-3 years of experience in Health and Welfare benefit consulting in ERISA & Non-ERISA plans

• 3 years of experience in client management in self-funding document creation and management

Senior Education and Experience:

• 3-5 years of employee benefits paralegal or similar job experience required

• 3-5 years of experience in Health and Welfare benefit consulting in ERISA & Non-ERISA plans

• 3-5 years of experience in client management in self-funding document creation and management

• Must have exposure to plan/policy documents, including amendments/SMMs, in prior work environments

Preferred Qualifications:

• Bachelor’s degree or equivalent job experience required

• A paralegal or related degree

• Phia Group’s PDM online portal document management experience or similar use of a portal for document creation and management, is a plus

• Worked with DOL Summary of Benefits and Coverage (SBC) templates and SBC Coverage Examples Calculator

• Exposure to plan/policy documents, including amendments/SMMs, in prior work environments is a plus

  • Senior Additional Qualifications:

    • Certifications in Compliance/Insurance are a plus

    • Claims Litigation experience and/or Insurance-related designation(s) are a plus

    • 1-3 years of prior training experience

Work Location:

• An ideal candidate would be able to work from home

• This position is remote

Who we are:

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.