Benefit Product Specialist

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Responsible for successful operational implementation of new and renewal products and modifications to the Presbyterian Health Plan/Presbyterian Insurance Company (PHP/PIC) product portfolio on an ongoing basis, which includes Commercial and Government Programs (Medicare and Medicaid); Responsible for the development, review, and revision of Schedules of Benefits, Subscriber Agreements, Explanation of Coverage, and other required materials for the product portfolio. Includes incorporation of regulatory requirements, implementation of decisions made by various PHP/PIC committee(s) related to benefits, and revisions to provide greater clarity to support consistent application/administration of benefits throughout the product portfolio

Some key responsibilities include:

• Orchestrate the revision/creation, productions, and filing of member benefit material, which includes Group Subscriber Agreements/Schedule of Benefits/Explanations of Coverage, Summary Plan Descriptions, Annual Notification of Change documents, and other sales collateral for new/enhanced plans utilizing communications, operations and regulatory/compliance department support within established quality and time measures.
• Ensure product compliance with state and federal regulations with the assistance of PHP Regulatory Operations and Compliance departments.
• Educate internal staff on existing and enhanced benefits and product design through the monitoring of research requests.
• Analyzes assigned PHP/PIC products for consistency, accuracy, and regulatory compliance by utilizing multiple interdepartmental business resources including research, data collection, and comparisons.
• Develop relationships with a cross-functional team of SMEs, including customers, to ensure support of the product deliverables and alignment of regulatory requirements (CMS and DOI), standards, PHP/PIC business strategies and market needs.
• Leads the successful implementation of new product/existing product enhancements for assigned products. Holds project team members accountable for their assignments and deliverables; Report update of projects and obstacles to Process/Product Owner.
• Assists in the development and editing of policies and procedures related to the post enrollment member materials.

Qualifications:

• Education: HS Diploma/GED required.
• 1 year experience in application, development and/or review of benefit plans associated with HMO, ASO, PPO, and/or Government programs.
• Must be able to demonstrate hands on/working proficiency with Microsoft Office software, Word and Excel.
  *Comfortable working with document development and management control software systems
• Requires above average analytical skills, excellent organization and communication skills, ability to meet deadlines, and ability to work efficiently in a fast-paced team environment.
• Demonstrated ability to conduct detailed research using internal and external resources.
• Experience in project management desirable

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.