at PacificSource in Boise, Idaho, United States
Job Description
Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Responsible for the development and accuracy for all commercial regulatory filed forms. This position requires independent judgement and decision making aptitude in the coordination and submission of Qualified Health Plan (QHP) binder filings submitted through NAIC System for Electronic Rates and Forms Filing (SERFF) by required deadlines. Role is a primary liaison between PacificSource and CMS and state insurance divisions in Oregon, Idaho, Montana for commercial filed documents.
Essential Responsibilities:
- Responsible for the accuracy, creation and development of commercial regulatory documents.
- Coordinate, as the subject matter expert, and must demonstrate independent judgement on the internal review and decisions of new and revised commercial regulatory documents to achieve filing approvals.
- Prepare state and federally accurate and compliant forms, submit all commercial required documents to respective state and/or federal regulators by established regulatory submissions due dates.
- Responsible for the coordination, preparation and filing of all Association and client specific documents as required by the state. Must be able facilitate correspondence and must possess the specialized skillset to ensure filing approvals.
- Lead cross functional team meetings throughout the filing process to ensure regulatory inquires meet state required timelines.
- Lead and facilitate discussions with operational areas in the company for form and binder filing objections received from state regulators. Must possess operations knowledge to script and submit responses within required timelines and to achieve filing approvals.
- Collaborate with internal departments to ensure benchmark requirements are met, collect and submit templates and supporting documentation required for QHP binder filings.
- Ensure a working collaborative relationship with state regulators to aid in filing and objection process to ensure filing approvals.
- Serve as a subject matter expert in providing direction to internal departments with the implementation of approved health insurance contracts, policies, and related documents.
- Maintain records of required regulatory documents filed with the respective federal and state agencies.
- Document and maintain records throughout the year of issues that are identified that will require revisions for the following filing.
- Participate and provide direction in the review of negotiated documents that do not require state regulatory filing.
- Review policy and procedures with all operational areas to ensure administration and processes are consistent with approved filed language.
- Actively participate as a key team member in department meetings.
- Collaborate and create policies and procedures, job aids and other appropriate documentation to perform essential job functions.
- Assist Business Analysts, as needed. Review benefit summaries, negotiated language for materials and forms, and other materials as created/altered.
Supporting Responsibilities:
- Provide assistance for Management and other internal departments as required for efficient functioning of the department.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum of three years of health insurance experience working with regulatory entities and SERFF filings required.
Education, Certificates, Licenses: High School diploma or equivalent required. Bachelor's degree in business or a related field is preferred.
Knowledge: Strong proficiency with interpretation of state and federal health insurance rules and regulations. Must possess a comprehensive understanding of PacificSource products, all filed commercial documents operations, and related materials. Strong research, analysis, organizational, and interpretative skills to provide direction and decisions to operational areas. Ability to research and understand state and federal regulatory requirements for filing documents. Ability to work under time constraints. Excellent written and oral communication skills. Strong attention to detail is critical. Ability to interpret complex contract language and clearly communicate with coworkers. Ability to prioritize responsibilities and diplomatically handle difficult situations. Strong Microsoft Office skills.
Competencies
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. To view full details and how to apply, please login or create a Job Seeker account
