Senior Benefits Analyst
About The Role
MagnaCare is seeking an ERISA Benefits Analyst to Multiemployer/Labor Union ERISA medical benefits administration, documentation and their successful conversion from a client’s Summary Plan Description (SPD) into an internal source document.
Primary Responsibilities
- The Senior Benefits Analyst’s job responsibilities include, but are not limited to:
- Review and interpret all clients plan documents, amendments, notices and summary plan descriptions to ensure that clients Self Insured Health Plans is administered accurately.
- Interpret and translate all clients benefit documentation into an internal source document and work with IT and Operations to ensure claims are properly coded into the claims system.
- Interface directly with clients to ensure proper interpretation of all benefits and plan rules, as well as ensure internal claims system is correctly adjudicating claims.
- Collaborate with various departments to assist with interpretation of clients' medical benefit plans, to ensure the correct information is being disseminated to team members, providers, and clients; claims are processing correctly; any necessary changes are being modified and programmed into the claims processing system.
- Assist in reviewing clients Summary Plan Description based on clients' current plan design(s), ensuring that the SPD correctly reflects current benefits set up and claims administration.
- Review clients benefit plans for compliance with all ERISA and PPACA guidelines. Provide recommended plan changes, as needed, and work independently with Medical Management and Legal Departments on policies and client communications.
- Assist in preparing, tracking, and maintaining all clients associated benefit documentation including but not limited to, summary plan descriptions (SPD), summary of benefit comparisons (SBC), summary of material modifications (SMM) and benefit summaries.
- Staying informed related to all changes to ERISA health benefits regulations and keeping clients and internal partners up to date.
- Providing creative, innovative and strategic expertise to clients and colleagues around the issues and emerging developments in the employee health benefits.
- Review clients ERISA medical benefit plans and make meaningful cost savings plan change recommendations.
Essential Qualifications
College Graduate or 15 years' work experience.
5 years benefits work experience.
Strong knowledge of Self-insured benefits.
Expertise in ERISA benefit regulations.
CEBS (or GBA) a plus.
Self-insured claims experience.
Union experience a plus.
Knowledge of claims processing and medical coding a plus.
Project management experience required.
About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.
Come be a part of the Brightest Ideas in Healthcare™.
Company Mission
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
DEI Purpose Statement
At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.
*We are an Equal Opportunity Employer
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