Health Plan Compliance Specialist
Relation Insurance Services
full-time
Posted on:
Location Type: Remote
Location: Oklahoma • United States
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About the role
- Creates, maintains, and updates PHIA-regulated Summary Plan Descriptions (SPDs) and Plan Documents for ERISA and non-ERISA health plans
- 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
- Supports the production and delivery of 80+ plan documents per month
- Participates in client implementation meetings to review benefit outlines
- Collaborates with cross-functional teams (e.g., implementation, compliance, operations)
- Conducts quality reviews to confirm plan documents accurately reflect approved benefit designs and regulatory requirements
- Maintains organized documentation records and version control
- 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
- Conduct the preparation, validation and submission of data and documentation for mandated filings listed above
Requirements
- High School diploma or equivalent
- Bachelor’s degree in Business, Health Administration, Public Policy, English, or related field; equivalent experience preferred
- 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
- 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
- Competitive pay
- A safe and healthy work environment provided by our robust benefit program including family health and wellness programs
- 401K
- employee assistance programs
- paid time off
- paid holidays
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
writingeditingproofreadingemployee benefitshealth plan conceptsHIPAA regulationshealth plan designplan document preparationdata validationregulatory compliance
Soft Skills
attention to detailability to manage multiple deadlinesindependencecommunication skillscollaboration skills
Certifications
Life Accident and Health License