HEALTH PLAN MANAGER

Occupational Summary

This is a leadership position responsible for leading Duke’s active and retiree health benefit plan administration to ensure the programs are of exceptional value to plan participants, competitively priced, compliant with regulations, and vendors provide exceptional service.   The Health Plan Manager leads all facets of the plan administration, inclusive of the active and retiree medical plan third party administrators, pharmacy benefit manager, disease management vendor, and COBRA administrator.  The Health Plan Manager is the Plan’s subject matter expert who stays apprised of current and emerging regulations and best practices, assures team members are well versed in communicating the plan provisions to plan participants, develops and leads educational sessions to assure understanding.  The Health Plan Manager is responsible for reviewing and assuring the timely and accurate contracting related to the Plans and that regulatory documents are up-to-date and compliant with regulations.  The Health Plan Manager has oversight responsibility for the dedicated service providers assigned to the Plan by the vendors, developing key performance indicators to advance the Plan’s service, participant experience, and ultimately improve health outcomes for participants. The role reports to the Associate Director – Health & Welfare Benefits, and works closely with other Plan Managers and other Human Resources/Benefits team members to ensure effective administration, communication, and customer service.

Work Performed

• Responsible for leading the design, analysis, and communication of the health plan design from concept through to implementation.  Is THE subject matter expert regarding the plans and responsible for developing plan materials, summary plan descriptions, benefit summaries and the delivery communications to key stakeholders as well as plan participants to assure understanding of the plan, proposed changes/modifications, and alternatives for consideration are accurately understood.
• Responsible for assuring HR colleagues responding to health plan questions have a deep understanding of the plan and is responsible for ensuring all health plan claims concerns are timely resolved, escalating within the respective vendor and/or counsel’s office as needed.
• Leads, evaluates, and proposes plan modifications, balancing regulatory implications, participant impact, financial impact, and strategy. 
• Regularly identifies and evaluates highly competitive, cost-effective options to meet the needs of employees, and that are consistent with Duke's business strategy.
• Regularly participates in and evaluates survey data to assure Duke’s plan is optimal in plan design,  emerging trends, and best in class. Identifies and leads through implementation the opportunities to improve competitiveness of plans both regionally and nationally.
• Is deeply and professionally engaged within the self-insured health plan marketplace, particularly as it relates to private higher education and health care industries, and develops, engages with colleagues in analyzing, and proposes modifications to Duke’s health plan coverage as a routine part of the position’s responsibilities.
• Is THE expert regarding the details of the health plan provisions, contracts and renewals, vendor agreements, BAAs, and payroll/IT processes as it relates to the health plan deductions/timing, and responds to escalated matters related to the above.
• Provides guidance and interpretation to other Benefits and HR practitioners in areas where plan provisions or regulations are unclear. Studies and evaluates changes to legal and regulatory requirements, implements plan design changes to ensure compliance, and manages ongoing adherence to plan compliance requirements.
• Maintains and applies understanding of legal and regulatory impacts, ERISA, DOL, IRS, MHPAEA, accounting, auditing, actuarial valuation, corporate disclosure, to help ensure operational compliance. Evaluates changes to legal and regulatory requirements; recommends changes to ensure compliance and protect the plan. 
• Ensures internal processes are compliant and technical support/safeguards are in place.
• Coordinates with HR and Benefits team members to provide technical support in the development of benefits-related communications to employees. Drafts educational materials and conduct sessions, such as town halls and webinars, to disseminate benefit plan changes across the University and Health System.
• Counsels analysts and HR call center representatives on benefits related issues.
• Directs the annual Plan review and annual audit processes, as well as any applicable non-discrimination testing, tax filings, notice delivery, and plan compliance requirements.
• Accountable for vendor management of the Health Plan vendors and leads the development of materials to enable the Health and Welfare Plan Committee’s selection and evaluation of the health plan vendors.  Vendor management includes leading the contractual processes (inclusive of renewals and calendaring of renewals), performance standards, audits, and plan coverage. Also, responsible for ensuring member issues are timely and appropriately addressed by vendors. 
• Meets regularly with vendors to resolve issues, provides feedback, and evaluates performance. Customizes programs for the Duke population using both in-house and vendor resources.
• Manages the content and compliance of required plan notifications, such as SBCs, Member Guides, SMMs, and NQTLs; provides annual review of documents.
• Ensures all notification and disclosure deadlines are met.

The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.

Required Qualifications at this Level

The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.

Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Minimum Qualifications

Education

Work requires a Bachelor's degree from an accredited institution, preferably in Business Administration or related field. A Master's Degree is preferred. Certified Employee Benefits Specialist (CEBS) or other benefits related coursework preferred.

Experience

Work requires seven years' experience in the employee benefits field, with at least two years serving in a leadership role responsible for leading and/or making senior level decisions related to a large, complex, benefit plan. The ideal candidate will have at least 6-8 years’ experience in administering complex employee benefits for a large employer, and practical experience with self-funded active and retiree health benefit plans. Must be proficient in Excel, as well as skilled in other computer software and the latest electronic technology.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.