Senior Legal Specialist Health Plan

Job Summary

The Senior Legal Specialist is a key member of the Priority Health Legal Specialists team. Someone in this role should have Self Funded Health Plan insurance experience. Creates and revises plan documents and service agreements in support of the Administrative Services (self-funded) line of business. Serves as a subject matter expert for Employer Solutions account managers supporting self-funded clients. Conducts research and recommends action to reduce risk for clients and the business. Monitors litigation and regulatory developments that may necessitate amendments to summary plan descriptions (SPDs) or administrative services agreements (ASAs) among others. Works collaboratively within the legal department and throughout the organization to achieve business goals.

Essential Functions

• Develops and reviews contracts and/or complex legal and regulatory documents that are of a high level of importance for the organization.

• Provides oversight and supervision of other individuals and functions as requested.

• Regularly leads complex projects from start to finish; including creating an effective project plan, presenting recommendations, meeting deadlines, proactively investigating and resolving problems, and collaboratively coordinating and leading others around process change.

• Manages, documents and regularly finds improvements and efficiencies for complex processes, procedures and outcomes to seek continuous improvement related to projects.

• Conducts research applicable to project assignment, gathers and complies data, interpret and analyze data, including creating written recommendations and reports with research findings with little direction required from manager.

• Regularly develops complex educational materials and communications, takes the lead on proposing, creating, and presenting educational programs and/or conducting training on subject matters with effective presentation skills for small or large groups.

• Designs, develops and maintains complex system programs and applications . Works on complex matters with a high level of importance to the organization independently or taking the lead to collaborate with a group of people and act as a change agent to advance initiatives.

• Takes the lead to effectively communicate and collaborate with others on complex matters, and act as a liaison to stakeholders/business partners in areas of a high level of importance to the organization. Cultivates relationships across the organization. Maintains a current level of knowledge and expertise in complex areas specific to assigned projects and documents knowledge, materials and advice to be used by others in the future.

Qualifications

Required:

• Bachelor's Degree or equivalent in legal, compliance, managed care, health plan administration, process improvement or project management

• 5 years of relevant experience substantive knowledge of the legal and regulatory environment applicable to the business unit(s) or subject matter area assigned

Preferred:

• 7 years of relevant experience substantive knowledge of the legal and regulatory environment applicable to the business unit(s) or subject matter area assigned

• 5 years of relevant experience previous leadership experience for projects and/or staff

• Project management experience

Physical Demands

• Pallet to Waist (6" from floor) > 5 lbs: Frequently up to 10 lbs

• Waist to Waist > 5 lbs: Frequently up to 10 lbs

• Waist to Chest (below shoulder) > 5 lbs: Frequently up to 10 lbs

• Waist to Overhead > 5 lbs: Frequently up to 10 lbs

• Bilateral Carry > 5 lbs: Frequently up to 10 lbs

• Unilateral Carry > 5 lbs: Seldom up to 10 lbs

• Pushing Force > 5 lbs: Seldom up to 10 lbs

• Pulling Force > 5 lbs: Seldom up to 10 lbs

• Sitting: Frequently

• Standing: Occasionally

• Walking: Occasionally

• Forward Bend

• Standing: Seldom

• Forward Bend

• Sitting: Seldom

• Trunk Rotation

• Standing: Seldom

• Trunk Rotation

• Sitting: Seldom

• Squat: Seldom

• Stair Climbing: Seldom

• Driving: Seldom

• Reach

• Above Shoulder: Seldom

• Reach - at Shoulder or Below: Seldom

• Handling: Occasionally

• Forceful Grip > 5 lbs: Seldom

• Forceful Pinch > 2 lbs: Seldom

• Finger/Hand Dexterity: Frequently

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Primary Location

SITE - Priority Health

• 1241 E Beltline

• Grand Rapids

Department Name

PH - Legal Services

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.