Plan Document Specialist

Description

Job Summary:

The Plan Document Specialist supports the Document Team in the creation, maintenance, and revision of plan documentation for both new and renewing business. This role is responsible for drafting and updating key materials such as Summary of Benefits & Coverage (SBC), Summary Plan Descriptions (SPD), Benefit Plan Descriptions (BPD), and Summaries of Material Modifications or Reductions (SMM/SMR). The specialist ensures all documents are accurate, compliant, and aligned with client and regulatory requirements.

Duties and Responsibilities:

• Support Plan Document Writers by preparing and updating medical benefit plan documents such as Summary of Benefits & Coverage (SBC), Summary Plan Description (SPD), Benefit Plan Descriptions (BPD), Summary of Material Modifications (SMM), and Summary of Material Reduction (SMR).
• Assist with incorporation of pre-approved document language changes resulting from administrative or legislative updates.
• Track document inventory and status, monitoring timelines from intake through delivery, ensuring deadlines are met.
• Edit and format plan documents using established templates or existing documents with guidance from senior team members.
• Submit assigned document updates and support tasks within defined Service Level Agreement (SLA) timeframes.
• Collaborate with internal stakeholders to verify document details and ensure accurate implementation of plan information.
• Perform research to support Plan Document Writers, using internal systems and regulatory resources to validate content accuracy.
• Maintain data integrity across multiple platforms for internal use and recordkeeping.
• Contribute to the development and maintenance of team procedure guides under direction of senior staff
• Provide general documentation support and coordination to help ensure document readiness for internal and external use.

Requirements

Required Knowledge, Skills and Abilities

• Bachelor’s degree or equivalent work experience, preferably in a healthcare or benefits TPA setting.
• 2+ years of experience in a healthcare, insurance, claims handling, quality control or plan document role. TPA business and process knowledge preferred
• Strong familiarity with medical and employee benefit terminology, including a clear understanding of the distinctions between various plan documents such as SBCs, SPDs, BPDs, SMMs, and SMRs.
• Ability to make sound decisions by proactively identifying issues, gathering and analyzing information, and effectively utilizing available resources; manage competing priorities
• Meticulous approach to reviewing and producing accurate content while adhering to structured processes and standardized templates.
• Willingness to work outside of regular business hours especially during peak periods, such as the fourth quarter, to address client needs and support project timelines.
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint, experience with SharePoint or other similar platforms
• Ability using a computer which includes expert keyboard and navigation skills and learning new programs.
• Communicate clearly and professionally with internal and external customers
• Work effectively individually and collaborate as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful.
• Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job.
• Make decisions using available resources and sound judgment.
• Maintain confidentiality and discretion.
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively.
• Share knowledge with associates by effectively communicating and providing follow-up
• Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.
• Work overtime as required.

Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus
• Occasional: Lift and/or move up to 10 pounds
• Constant: Regular, predictable attendance in the office is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending.

Work Environment - The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

Pay may vary based on location. Offers will be adjusted based on an individual's experience, education, and other job-related factors as permitted by law. Pay range is: $25-32/hr

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.