Benefit Development Specialist II

• Lead ongoing benefit development activities, including auditing complex benefit contracts and overseeing benefit change proposals to ensure compliance with state and federal laws.
• Track, analyze, and present regulatory updates to the Product Platform Team, and respond to inquiries from regulators regarding benefit design and compliance.
• Partner with cross-functional teams — including Product Development, Sales, Actuarial, and Marketing Communications — to implement, communicate, and monitor benefit-related activities.
• Lead the Medicare benefit design bid submission process to CMS for the Medicare PPO line of business, including competitive research and benefit analysis.
• Analyze competitive benefit trends and communicate strategic implications to internal management to help drive the product development process.
• Prepare and deliver benefit presentations and training to internal and external audiences, and respond to RFP/RFI proposals regarding benefit information and design.
• As a member of our strong leadership community, provide direction to your team, engage them towards common goals, and create a positive experience that helps people flourish.

• Bachelor's degree in Business, Healthcare, or a related field.
• Minimum of five years of experience in benefit administration, project coordination, or an equivalent combination of education and experience.
• Broad knowledge of the health insurance industry, including benefit design, market demands, and compliance requirements.
• Extensive knowledge of benefit regulations at both the Cambia service area and federal levels.
• Demonstrated ability to think analytically, gather benefit information from diverse sources, and deliver in-depth analysis and actionable recommendations.
• Experience in report preparation, project documentation, or policy and procedure writing, including the ability to interpret statistical data and communicate findings clearly.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
• Excellent written and verbal communication skills, with the ability to engage effectively at all levels of management; strong presentation skills required.
• Demonstrated ability to organize, prioritize, and manage workload effectively while adapting to shifting priorities.
• Proven ability to lead and mentor team members in a fast-paced environment to achieve departmental goals and objectives.
• Demonstrated ability to collaborate effectively across all levels of the organization.

Demonstrates expertise in benefit design and compliance within the health insurance industry, with a strong focus on regulatory analysis and cross-functional collaboration. Proven ability to lead teams, deliver presentations, and manage complex projects effectively.

• Benefit Design
• Regulatory Compliance
• Project Coordination
• Team Leadership
• Analytical Skills

• Benefit Administration
• Market Analysis
• Report Preparation
• Policy Writing
• Statistical Data Interpretation

• Excellent Communication Skills
• Organizational Skills
• Mentoring
• Collaboration

• Health Insurance
• Benefit Regulations
• Medicare
• Competitive Research
• Product Development

• AI Tools