Business Analyst II

Company Name:
PacificSource Health Plans
Support the development, research, implementation, and maintenance of products, annual state filings, group and individual materials, Caremark set-up and reporting, custom language, and IT system builds and testing. Responsible for reviewing, compiling, coordinating, and communicating benefits and eligibility for potential, new, and renewing large groups. Spec, code, and map new or custom products and materials. Ensure accuracy and legal deadlines to ensure compliance and to support other departments in providing customer service.
1. Act as large group specialist. Review prior carrier materials for matched variations. Coordinate variations and exceptions. Work directly with Facets Business Support and Compliance to confirm administrative ability and legal compliance.
2. Develop and maintain language and coding specs for standard and custom handbooks, summaries, contracts, and renewal letters in eXtream, PSEx, Excel, Adobe Professional, and/or Word. Distribute for posting on website, InTouch, or RFPs and for filing. Coordinate with Communications on collateral pieces for books.
3. Set-up and communicate new and changing benefit plan designs and new eligibility styles.
4. Set-up and update plan profiles, product profiles, and other coding in PSEx, map or implement triggers for eXtream, coordinate with IT for Facets set-up and eXstream coding, and with Caremark for pharmacy plan set-up and transitions.
5. Develop and maintain group and individual materials from pre-filing through post-implementation for all commercial products, ensuring consistency in language and compliance with state and federal regulations, and PacificSource policies.
6. Submit custom Facets product set-up requests to Facets Business Support, and research.
7. Test and assist with the development PSEx and eXstream upgrades prior to release to company. Act as lead to ensure all functional areas test the systems that impact their areas.
8. Maintain job aids and train staff throughout the company on the use of PSEx and new releases. Prepare and conduct educational meetings for specific departments or for all employee meetings.
9. Prepare custom benefit summaries or other documents for internal and external use.
10. Work with the sales and service staff to determine large group variations and renewal changes.
11. Research set-up issues in Facets or PSEx for various departments, communicates system problems and possible solutions to IT; communicate resolution to staff. Act as liaison with IT regarding system issues or features, submitting help desk tickets and testing resolutions.
12. Support the product filing process by reviewing and auditing forms, entering product and plan information into templates for the annual product filing.
13. Document and track information related to products, plans, and benefit changes to PacificSource products. Prepare related spreadsheets to assist the Group Account in processing groups.
14. Coordinate with the Compliance, Facets Business Support, and Product Development to ensure new products, eligibility, and variations and meet regulatory requirements, PacificSource policies, and ability to administer in the Facets claims and eligibility system.
Supporting Responsibilities:
1. Meet department and company performance and attendance expectations.
2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
3. Perform special projects and other duties as assigned.
Work Experience: Experience in insurance industry and in a position that required research, presentations, and effectively managing multiple projects and deadlines.
Education, Certificates, Licenses: Requires a high school diploma or equivalent. BA/BS preferred.
Knowledge: Strong working knowledge of state and federal laws affecting group health insurance. Thorough knowledge of PacificSource products, contracts, and work flow. Understanding of general underwriting risk concepts. Strong skills in Microsoft Word, Excel, and Powerpoint. Consistently helpful, confident, and pleasant with internal and external customers. Consistently and effectively pays attention to detail, produces high quality work in a timely manner, and strives to increase production without sacrificing quality. Handle sensitive issues with diplomacy and persuasiveness.
Our Values
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Work Standards
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customers' experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource Health Plans is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, age.
Date: 2014-06-03
Country: US
State: OR
City: Springfield
Postal Code: 97477
Job Type: Regular Full-Time

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.