Plan Document Specialist

2 days ago


Sandton, South Africa HR Studio Ltd Full time
Job Description

Job Title: Plan Document Specialist

Job Summary:

We are seeking a highly skilled Plan Document Specialist to join our team at HR Studio Ltd. The successful candidate will be responsible for creating, maintaining, and updating medical plan documents, including the Summary of Benefits & Coverage (SBC), Summary Plan Description (SPD), Benefit Plan Descriptions (BPD), and Summary of Material Modifications (SMM) or Summary of Material Reduction (SMR).

Key Responsibilities:

  • Collaborate with the Plan Document Writer to research and amend medical plan documents.
  • Assist with incorporating new language to support legislative or administrative changes.
  • Oversee the inventory and status of documents from initial need through publication.
  • Ensure deadlines are met.
  • Modify benefit design and information using templates or existing documents.
  • Submit completed documents or projects within Service Level Agreement (SLA) timeframes.
  • Work closely with internal customers to ensure the correct documentation is in place.
  • Investigate plan document questions using internal and external sources to validate responses and address documentation issues.
  • Maintain accurate data across various platforms for a range of end users.
  • Write procedure documentation in alignment with business goals and legal requirements.
  • Provide timely documentation to users to help them understand and reference how plan changes impact the system.
  • Publish, proofread, and edit documents to ensure ongoing compliance and quality.

Requirements:

  • Matric Bachelors degree or equivalent work experience preferably in a healthcare or benefits TPA setting.
  • 2 years of experience in claims handling, quality control or plan document experience in a healthcare setting.
  • Familiarity with, and an understanding of the differences in, each type of Plan Document: SBC, SPD, BPD, SMM, and SMR.
  • Knowledge of medical procedure terminology preferred.
  • Ability to maintain confidentiality and exercise discretion in handling sensitive information.
  • Proficiency in Microsoft Office.

Working Hours: 2pm - 11pm



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