Kaiser Permanente BENEFIT POLICY CONSULTANT in Oregon, Oregon
Develops implementation plans and performs implementation of new benefits or benefit modifications (medical or dental). Provides internal and external consulting service for medical or dental benefit related functions. Responsible for the management of Regional and National medical or dental benefit initiatives including policy development, recommendations and implementation. Responsible for ongoing development and maintenance of Regional and National benefit information such as Nat'l Available For Sale tools, etc. Participation in quality assurance activities to ensure accurate medical or dental benefit communication and administration.
Essential Functions: - Benefit Assessment: Provide thought leadership on benefit specific issues and relationship to overall product strategy. Coordinate with Product Managers on business risk assessments of benefit issues. Perform research and analysis of benefit issues, including new benefit designs and policy development. Staff regional or national committee's to assess new benefits, policies, or legislation. E.g Interregional Benefit Design Group (IBDG); Regional Benefits Committee (RBC). Provide RFP (Request For Proposal) and RFI (Request for Information) support for benefit related questions. Consult with Sales/Marketing staff on group renewals. Oversee benefit exception process. - Benefit Interpretation: External and internal resource for benefit related questions, issues and concerns. Prepares and presents customized benefit presentations to internal and external customers. Define and clarify policies for existing benefits which are specified generally in the Medical or Dental contracts but require guidelines for consistent and equitable administration. - Benefit Implementation: Facilitate the implementation of benefit initiatives/enhancements and other projects by coordinating cross-functional teams across Health Plan (locally and nationally) and clinical operations. Partners with HPSA (Health Plan Services Administration) and other downstream system partners to ensure accurate interpretation and business rules for benefits. - Benefit Maintenance: Coordinate and ensure accuracy of communications regarding benefits (e.g. member collateral; Evidence of Coverage Benefit Summaries). Maintain, monitor, and manage the benefit content of website tools including Benefit&Eligibility Administration Manual (BEAM) and Product&Benefit Management (PBM) web-sites; and Available For Sale (AFS). Act as Regional liaison for National initiatives that require an escalation agent for production support issues (e.g. Self Funded Administrative Services unit support needed within Region). - Perform other duties as requested.
Qualifications: Basic Qualifications: Experience - Minimum three (3) years of experience interpreting and/or informing others about benefit products. - Minimum three (3) years of experience working in a health care/insurance environment with exposure to marketing or benefits. Education - Bachelor's degree 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: - Working knowledge of various analytical approaches including financial, decision making and market research. - Working knowledge of PC and mainframe computer systems, and MS Office. - Working knowledge of dynamics and trends in health insurance industry and products in addition to HMOs. - Proven relationship management skills - must gain cooperation and acceptance/approval in resolving problems, and/or negotiating with other stakeholders to arrive at an agreement. - Strong writing and presentation skills, including the ability to clearly and concisely explain product information to a variety of audiences. - Ability to synthesize a variety of data to produce a cohesive and well-documented product. - Strong research and organizational skills. - Proven knowledge of project management principles and approach. - Demonstrated ability to interpret quantitative and qualitative analyses and to communicate these to a variety of audiences. - Demonstrated ability to effectively use word processing, spreadsheet, and presentation software. - Demonstrated ability to motivate colleagues to embrace needed changes and instill confidence and respect in them. - Proven ability to support colleagues and department objectives by learning new skills and demonstrated willingness to expand knowledge base. - Ability to analyze barriers to change, evaluate to determine which barriers are critical and proceed with implementation solution which best minimizes critical barriers.
Preferred Qualifications: - Minimum five (5) years (three (3) or more years with Master's degree) progressive experience in marketing, operational or technical areas related to Health Care products, benefit design, and benefit policies. - Minimum five (5) years (three (3) or more years with Master's degree) of management of complex projects with minimal experience, preferably in health care product management. - Knowledge of various analytical approaches including financial, decision making and market research. - Knowledge of word processing, spreadsheet, and presentation software. - Knowledge of the dynamics and trends in health insurance industry and products. - Knowledge of state and federal regulatory requirements in regards to products and benefits. - Familiarity with Kaiser Permanente operations and planning processes. - Relationship management skills - must gain cooperation and acceptance/approval in resolving problems, and/or negotiating with other stakeholders to arrive at an agreement. - Ability to effectively manage several projects at once. - Ability to effectively use PC and/or mainframe computers and MS Office. - Ability to analyze barriers to change, evaluate to determine which barriers are critical and proceed with implementation solution which best minimizes critical barriers. - Master's degree in business administration, economics, finance, marketing, health policy or related area.
*Note: This position is not eligible for relocation assistance.
COMPANY Kaiser PermanenteTITLE BENEFIT POLICY CONSULTANTLOCATION Oregon, ORREQNUMBER 632602
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.