Paralegal / Contract Specialist

Paralegal / Contract Specialist

Elite Technical is seeking a Paralegal / Contracts Specialist for our customer, a major Healthcare payor organization. The selected candidate will work closely with Corporate Governance (Legal), Government Affairs, Product, Marketing, Mandates, Health Services, and Strategy and Transformation providing editing support for contract form compliance. This position supports Benefit Contract Management (BCM) by performing accountabilities/tasks that include but are not limited to: analyzing proposed changes to contract forms and templates; recommending filing strategies; revising contract language; reviewing contract forms, templates and related marketing materials; reviewing and tracking mandates.

ESSENTIAL FUNCTIONS

• Modify group and individual, indemnity and HMO, contracts and certificates for risk and self-insured accounts. Files all forms with the respective Insurance Administrations and regulatory agencies as appropriate also to ensure legal compliance of forms as known.
• Responds to Insurance Administration inquiries; completes Insurance Administration surveys as needed and assigned. Responds to Central Appeals Unit, Executive Inquiry, Corporate Audit and other department inquiries that are of an -elevated- status. Consults with the Legal Staff, Government Affairs and other departments as necessary. Researches appropriate local and federal code and regulations. Produces all production forms; writes and maintains implementation documentation, and provides detailed implementation instructions.
• Audits Contracts and other special documents to ensure accuracy and resolves issues with necessary departments. Participates/leads in Company initiative implementation and Operations meetings and other meetings that affect contracts and certificates such as the Legislative Review Committee and Team Implementation Meetings; participates in the implementation of other Company initiatives and projects. Audits Account Installation master documents and procedures for compliance.
• Monitors performance of contracts for conformance to contractual terms and conditions and ensures that contracts are in accordance with legal requirements, customer specifications, laws, and regulations. Interprets benefit issues, provides contract interpretations; resolves complex issues and benefit interpretations with the Legal staff, Health Care Policy, etc. as necessary.

Required Skills

• Education Level: Bachelor's Degree,
• Paralegal certificate considered a plus
• Experience: 5 years experience in a Paralega/ Legal Contracts position within a health insurance organization providing benefits delivery systems or contract management.

-Must have strong Legal Contracts review and editing expertise

• Knowledge of health insurance products/contracts
• Strong attention to detail
• Excellent communication skills both written and verbal
• Strong time-management and organizational skills
• Proficient in Microsoft Office applications

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