As a member of Kaiser Permanente Colorado's team, you'll be proud of the contributions you make every day. From our financial professionals and IT team members to our RNs and physicians on the front line of care-we work together to advocate the health and well-being of our members, colleagues, and communities. And we do it all in an environment known for breathtaking scenery. Maintaining a close relationship with the natural beauty that surrounds them, the cities of Denver, Boulder, Longmont, and Colorado Springs offer something for everyone-from historic districts to family neighborhoods to world-class ski resort trails. Prepare to be inspired.

Provides analysis to develop, design, implement, maintain & support new/existing product & benefit system administration both internally & w/ external vendors. Maintains knowledge of policies & procedures & performs in accordance w/ applicable regulatory requirements, external laws & accreditation standards as they relate to Membership/Benefit Administration; Marketing, Sales & Business Development; Care Delivery; & Claims Administration. Maintains knowledge of & assures departmental compliance w/ KP's Principles of Responsibility & policies & procedures, & applicable regulatory requirements & accreditation standards. Responds appropriately to observed fraud or abuse.

Essential Functions:

- Analyzes & interprets benefit/plan related documentation to include, but not limited to state & federal legislation
- Provides recommendations to implement & administer new/existing products & benefits considering customer, clinical, pricing & regulatory implications
- Provides professional/technical guidance & training to team to implement & administer new/existing products & benefits
- Documents benefit/plan requirements, creates, implements & maintains benefits/plans to meet regulatory & internal/external benefit administration needs
- Maintains & updates Benefit Administration systems/databases, e.g., web-based & legacy systems, w/ complex detailed benefit information to support products, benefits, membership, contracts, claims & care delivery
- Ensures benefit/plan information quality & compliance
- Develops & performs quality assurance processes
- Knowledgeable in all applicable Kaiser policies, local, state & federal laws & regulations, & accreditation standards
- Acts as a source-matter expert for benefits
- Troubleshoots benefit issues daily & recommends/implements solutions
- Interacts, coordinates, influences a wide variety of internal customers to include, but not limited to Sales, Product Development, Underwriting, Contracts, Claims, & KP HealthConnect
- Data management through creation of spreadsheets & reports in Microsoft Excel & Access
- Selects methods & techniques for obtaining technical solutions for design, development & implementation of new & improved processes, tools & system enhancements
- Performs Project Lead role for Benefit Administration projects as needed
- Creates & manages project tasks & milestones as they relate to the Benefit Administration team
- Prepares training materials & communication updates & conducts training both in a group & one-on-1 setting
- Assists w/ data validation, auditing & user acceptance testing
- Participates in regional or national projects as assigned
- Other duties as assigned
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the KP Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
- Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors

Basic Qualifications:

- 5 years of work experience w/ benefit or claims administration/configuration/analysis required
- Bachelor's degree or equivalent experience in business or health care/insurance administration
- Strong detail & quality orientation essential
- Thorough knowledge of managed care, indemnity insurance, alternate funding, self funding, state, & federal regulations
- Excellent interpersonal & communication skills - verbal & written
- Self-motivated team player who can work independently w/ limited management direction & who can work collaboratively w/ various stakeholders is required
- Strong problem solving & diagnostic skills required
- Strong process/work flow development & execution skills required
- Ability to adapt to constantly changing environments & priorities required

Preferred Qualifications:

- 3 years of business systems analysis/administration preferred
- Claims coding and/or adjudication experience helpful
- Proficiency in Microsoft Office Suite, advanced Excel skills preferred

Primary Location: Colorado-Aurora

Scheduled Hours (1-40): 40

Shift: Day

Working Days: Mon - Fri

Working Hours Start: 8:00 am

Working Hours End: 5:00 pm

Schedule: Full-time

Job Type: Standard

Employee Status: Regular

Employee Group: Salaried Employees

Job Level: Individual Contributor

Job: Insurance / Claims

Public Department Name: Contract Administration

Travel: No

Job Eligible for Benefits: Yes

External hires must pass a background check/drug screen. We are proud to be an equal opportunity/affirmative action employer.