[Remote] Health Plan Specialist

Note: The job is a remote job and is open to candidates in USA. Edison Health Solutions, a Relation Insurance company, is a leading organization in the insurance market, seeking a Health Plan Specialist. This role involves creating and maintaining compliant health plan documentation and ensuring that all materials meet regulatory requirements while collaborating with cross-functional teams.

Responsibilities

• Creates, maintains, and updates PHIA-regulated Summary Plan Descriptions (SPDs) and Plan Documents for ERISA and non-ERISA health plans, ensuring compliance with all applicable regulations
• Produces Summaries of Benefits and Coverage (SBCs) in accordance with federal and state compliance requirements
• Manages plan renewals and drafts plan amendments, ensuring accuracy, consistency, and timely delivery across a high-volume document environment
• Supports the production and delivery of 80+ plan documents per month, adhering to established timelines and quality standards
• Participates in client implementation meetings to review benefit outlines, clarify plan requirements, and gather all necessary information prior to document creation
• Collaborates with cross-functional teams (e.g., implementation, compliance, operations) to ensure plan materials are aligned, compliant, and reflective of client expectations
• Conducts quality reviews to confirm plan documents accurately reflect approved benefit designs and regulatory requirements
• Maintains organized documentation records and version control in accordance with internal procedures and compliance standards
• Performs other projects, duties, and tasks, as assigned

Skills

• High School diploma or equivalent
• Bachelor's degree in Business, Health Administration, Public Policy, English, or related field; equivalent experience preferred
• Strong writing, editing, and proofreading skills with attention to detail
• Basic knowledge of employee benefits and health plan concepts (medical, Rx, dental, vision, HSA/HRA/FSA)
• Working knowledge of the laws and regulations associated with HIPAA
• Knowledge of and basic understanding of benefit plans & terminology
• Willingness to adhere to all principles of confidentiality
• Proficiency with Microsoft Word (templates/styles), Excel, and Adobe Acrobat
• Ability to manage multiple deadlines in a fast-paced, high-volume environment
• Excellent communication and collaboration skills
• A Life Accident and Health License from state of domicile is preferred
• Certified in Healthcare Compliance (CHC) is helpful
• Familiarity with plan document generation platforms or template libraries preferred
• Exposure to ERISA, ACA, HIPAA, COBRA, MHPAEA, and state benefit mandates preferred
• Familiarity with SBC templates and plan document generation platforms preferred

Benefits

• Family health and wellness programs
• 401K
• Employee assistance programs
• Paid time off
• Paid holidays

Company Overview