Essential Duties and/or Responsibilities:

  • Analyze and interpret previous carrier’s documents to generate a customized plan document for distribution to; Internal Operational Team members, the Client, Stop Loss Carrier, Associated Cost Containment Vendors and Utilization Management Team. This process may include consultation with the client, internal Claims and Stop Loss operational teams and external vendors, as necessary;
  • Identify, research, develop and amend documents in order to support and comply with legislative requirements, client requests, and/or industry practices.
  • Assist in education and informational communications to internal and external clients about existing and new plan compliance requirements (annual plan notices, SBCs, etc.) due to existing and new legislative regulations;
  • Work with supporting departments to resolve issues or provide required information when benefit interpretation varies;
  • Review, develop and update Summary of Benefits and Coverage in order to comply with legislative requirements, plan changes, and client requests.
  • Perform other projects or tasks as required.

Knowledge, Skills and Education Required:

  • Five years of experience in employee benefits, document drafting, or equivalent is preferred
  • Comprehensive knowledge of both group health insurance and employee benefits as well as knowledge of claim payment methodology
  • Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations.
  • Ability to organize material according to set standards regarding order, clarity, conciseness, style and terminology
  • Effective business correspondence skills, including issuing prompt and detailed accurate follow-up
  • Excellent interpersonal and communication skills (written and verbal)
  • Commitment to a team-oriented office environment
  • Proficient with Microsoft Word, Outlook, Excel
  • Strong client focus and service-oriented
  • Strong planning and organizational skills

Attributes of a Successful Compliance Specialist

  • Self-managed, autonomous
  • Detail oriented
  • Well-organized
  • Accountable
  • Flexible
  • Precise and accurate
  • Strong communication skills

Equal Employment Opportunity Policy Statement: Lucent Health Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.