Benefits Administrator
Business Wire
Associate General Counsel, Benefits Administration and Service Contracts
Quantum Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Ohio
Visit company websiteJob Level
JuniorMid-Level
About the role
- Location: This position may work remotely anywhere in the United States of America or may work hybrid from our Dublin, Ohio location. The Associate General Counsel – Benefits Administration & Service Contracts serves as a trusted legal advisor on matters related to employer sponsored group health plan administration, including, but not limited to ERISA, ACA, MHPAEA, Medicare, state insurance law and HIPAA compliance, fiduciary governance, and general contract negotiation as a service provider to group health plan sponsors and downstream vendor service agreements. This role supports the legal team providing first-level support for operational compliance issues related to utilization management programs, wellness program incentive management, claim and appeal administration support, and clinical excellence in addition to negotiating complex client and downstream vendor service contracts in partnership with cross-functional stakeholders. Negotiate and draft client and downstream vendor contracts, as well as contracts with third-party administrators (TPAs), pharmacy benefit managers (PBMs), wellness vendors, stop-loss carriers, point solutions, and insurers. Provide strategic counsel on the design, implementation, and administration of health and welfare benefit plans, including medical, dental, vision, EAP, wellness, and flexible spending accounts (FSAs). Ensure compliance with all applicable laws and regulations, including ERISA, HIPAA, ACA, COBRA, and relevant state insurance laws. Draft, review, and maintain plan documents, summary plan descriptions (SPDs), and related participant communications to ensure regulatory compliance and clarity. Respond to and resolve benefits-related disputes, claims, and appeals, including oversight of external counsel when necessary. Monitor and interpret legislative and regulatory developments affecting health and welfare benefits and implement timely updates to policies and practices. Assist in internal and external audits, DOL investigations, or inquiries related to benefits or vendor contracts. Provide education and training to internal stakeholders on fiduciary obligations, plan administration, and contract compliance. Perform additional duties and special projects as assigned.
Requirements
- Education: Juris Doctor (J.D.) from an accredited law school. Licensure/Certifications : Active license to practice law in a U.S. state. 7+ years of legal experience, with significant expertise in health and welfare benefits, ERISA fiduciary matters, and vendor contract negotiation and management. In-house counsel experience with a focus on employee benefits and health plans strongly preferred. Benefit litigation experience would be a strong plus. Deep knowledge of ERISA, HIPAA, ACA, COBRA, IRS regulations, and other laws impacting group health plans and employee benefits. Strong understanding of fiduciary responsibilities under ERISA. Demonstrated success managing and negotiating client and partner contracts, including performance metrics and compliance terms. Ability to analyze and explain complex legal concepts clearly and concisely to business leaders. Exceptional drafting, communication, and negotiation skills. Strategic thinker with a pragmatic, business-oriented approach to legal problem-solving. Comfortable working in fast-paced, cross-functional environments with competing priorities. Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently. A high degree of personal accountability and trustworthiness, a commitment to working within Quantum Health’s policies, values and ethics, and to protecting the sensitive data entrusted to us.
