Health Plan Documentation Specialist - The Phia Group

The Phia Group’s “Phia Group Consulting” or “PGC” team is responsible for providing guidance to employers, health benefit plans, insurance carriers, brokers, claims processors, and third party administrators. This organization does everything from reviewing applicable laws to ensure benefit plan compliance, to drafting benefit plan documents (policies). From aiding decision makers in assessing complicated scenarios to researching rules and regulations, our consultants are constantly challenged by this thrilling industry.

As a Health Benefit Plan Documentation Specialist, you will draft, analyze and review health plan documents and plan amendments. Communicate with clients regarding plan documents. Assist our PGC department team members and clients with our online Plan Document drafting software (i.e. coding, testing, updating, and training clients).

At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their dependents, you can look forward to not only exceptional benefits for yourself but also being immersed in a company that has been named one of USA Today’s top workplaces for 2024. We believe that this distinction, which stems from the fourth annual survey co-sponsored by Energage and USA Today, reflects our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees.

The Phia Group is committed to fostering, cultivating and preserving a culture of diversity and inclusion. With this in mind, we always seek to attract and develop candidates who share our passion for the healthcare industry and our commitment to diversity and inclusion. We encourage applicants who share that passion to explore this opportunity to join our dynamic team.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Consultation

• Analyze, draft, edit and review health plan documents and plan amendments for self-funded and other plans as required.
• Review documents for federal and state law compliance and cost containment.
• Provide language recommendations to improve plan documentation.
• Follow relevant best practices, company templates and policies and utilizes editing features of software to show client’s plan document changes.
• Research state and federal mandates applicable to self-funded employee benefit plans.
• Responsible for identifying issues and non-standard provisions.

Product Development

• Creating / Implementation of the client specific template and checklists onto the PDM system.
• Will assist in coding the PDM templates / checklists
• Update the software developer team on testing of product enhancements and what can be pushed to the “live” server
• Testing of the developed product enhancements
• Maintaining and/or keeping the client checklists and templates up to date per client requests and per compliance with healthcare regulations.

General

• Maintain security and confidentiality of client plan information.
• Communicate with appropriate team members to build context to ensure changes are well documented and easily understood.
• Streamline the process of gathering and compiling data, drafting documents, editing, submitting and record keeping.
• Perform other duties as requested or required.

Experience and Qualifications

• Bachelors Degree or equivalent combination of education and experience preferred.
• Ability to listen and communicate (written and verbal) with all levels of staff, vendors and clients.
• Proficiency with Microsoft Office Word, Excel and Outlook applications.
• Ability to perform at high levels in a fast paced ever-changing work environment.
• Ability to anticipate work needs and follow through with minimum direction.
• Proficient organizational, time management and prioritization skills.
• Proven ability to have strong accuracy and attention to detail skills.

Working Conditions / Physical Demands

Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines.

This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary.

External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.