Contract & Policy Analyst III

Company Name:
Kaiser Permanente
Provides support to Membership and Benefit Administration and benefit, policy and contract administration activities. Which includes; benefit and administrative policy interpretation for all lines of business and products; develops and drafts contract language; and through a variety document development, design and publishing activities to ensure efficient and cost effective document development that meets our customer's needs.
Essential Functions:
- Research and analyze new and changed Medicare, federal, or state mandates for impact to contractual documents.
- Ability to draft and develop, edit and update moderate to complex, non-routine contract language and create contractual documents (e.g., Evidence of Coverage, Group Agreements, Summary of Benefits and Coverage, etc.) to reflect new benefits, modifications to existing benefit and/or services, and policies to ensure compliance requirements.
- Analyze and respond to requests for contractual changes, based on research of legislative and regulatory requirements and company policies and procedures.
- Administrative Policy Manual.
- Analyzes, problem solves and recommends solutions to contract document development issues and problems.
- Routinely makes decisions regarding development and implementation of benefits and contract policy and processes and coordinates with sales and other cross functional areas to achieve desired results.
- Reviews and maintains Group Agreements and responds to group-specific requests regarding the group agreement and letters of agreement. Includes but is not limited to: negotiation of contract terms with group and its legal counsel using when necessary internal legal resources.
- Manage multiple assignments simultaneously, while working independently and with others within the team and cross functionally.
- Provides oversight to document filings and/or prepares documents for filing with appropriate regulatory compliance agencies.
- Responsible for developing and maintaining desk top manuals of functions performed in this position.
- Analyze request for proposal submission, clarify technical capability, note errors, discuss and negotiate whether or not and under what conditions proposal would be acceptable.
- Acts as a liaison with Program Office legal as appropriate.
- Performs other duties as assigned by management.
Basic Qualifications:
- Minimum four (4) years in health insurance contract administration/management, benefit administration, compliance, or other related experience.
- Bachelor's degree in law, business, health care of public administration OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Demonstrated ability to perform administration activities associated with contracts, including interpreting contract provisions, contract negotiation with external parties, developing contract language; preparing documentation of contract provision(s) for reporting to insurance commission and/or other regulatory or government agencies.
- Strong analytical skills.
- Strong detail and quality orientation.
- Excellent interpersonal and communication skills - verbal and written.
- Strong organizational and time management skills.
- Strong working knowledge of Microsoft Word and Excel.
- Ability to handle multiple tasks effectively with competing deadlines.
Preferred Qualifications:
- Working knowledge of managed care or indemnity insurance products.
- Successful completion or graduation from an ABA approved paralegal program.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.

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