Corporate Counsel

Who weare

Founded in 1999 and headquartered in Central Ohio were a privately-owned independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone and were on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted tech-savvy team fights to ensure that our members get the care they need when they need it at the most affordable cost thats why we call ourselves Healthcare Warriors.

Were committed to building diverse and inclusive teams more than 2000 of us and counting so if youre excited about this position we encourage you to apply even if your experience doesnt match every requirement.

About the role

The Corporate Counsel Benefits Administration & Service Contracts serves as a trusted legal advisor on matters related to employer sponsored group health plan administration including but not limited to ERISA ACA MHPAEA Medicare state insurance law and HIPAA compliance fiduciary governance and general contract negotiation as a service provider to group health plan sponsors and downstream vendor service agreements.

This role supports the legal team providing first-level support for operational compliance issues related to utilization management programs wellness program incentive management claim and appeal administration support and clinical excellence in addition to negotiating complex client and downstream vendor service contracts in partnership with cross-functional stakeholders. The ideal candidate will bring broad experience in group health plan design appeal letter drafting reporting and disclosure obligations and a deep knowledge of the health plan industry.

Location: This position may work remotely anywhere in the United States of America or may work hybrid from our Dublin Ohio location.

What youll do(Essential Responsibilities)

• Negotiate and draft client and downstream vendor contracts as well as contracts with third-party administrators (TPAs) pharmacy benefit managers (PBMs) wellness vendors stop-loss carriers point solutions and insurers.
• Provide strategic counsel on the design implementation and administration of health and welfare benefit plans including medical dental vision EAP wellness and flexible spending accounts (FSAs).
• Ensure compliance with all applicable laws and regulations including ERISA HIPAA ACA COBRA and relevant state insurance laws.
• Draft review and maintain plan documents summary plan descriptions (SPDs) and related participant communications to ensure regulatory compliance and clarity.
• Respond to and resolve benefits-related disputes claims and appeals including oversight of external counsel when necessary.
• Monitor and interpret legislative and regulatory developments affecting health and welfare benefits and implement timely updates to policies and practices.
• Assist in internal and external audits DOL investigations or inquiries related to benefits or vendor contracts.
• Provide education and training to internal stakeholders on fiduciary obligations plan administration and contract compliance.
• Perform additional duties and special projects as assigned.
• Other duties as assigned

What youll bring (Qualifications)

• Education: Juris Doctor (J.D.) from an accredited law school.
• Licensure/Certifications: Current and active license to practice law in a U.S. state.
• Experience: 5-10 years of legal experience with significant expertise in health and welfare benefits ERISA fiduciary matters and vendor contract negotiation and management.
  • In-house counsel experience with a focus on employee benefits and health plans strongly preferred.
  • Benefit litigation experience would be a strong plus.
  • Deep knowledge of ERISA HIPAA ACA COBRA IRS regulations and other laws impacting group health plans and employee benefits.
• Strong understanding of fiduciary responsibilities under ERISA.
• Demonstrated success managing and negotiating client and partner contracts including performance metrics and compliance terms.
• Ability to analyze and explain complex legal concepts clearly and concisely to business leaders.
• Exceptional drafting communication and negotiation skills.
• Strategic thinker with a pragmatic business-oriented approach to legal problem-solving.
• Comfortable working in fast-paced cross-functional environments with competing priorities.
• Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook Word Excel PowerPoint) IM/video conferencing (Teams & Zoom) and telephones efficiently.
• Experience with Ironclad contract management software a plus.
• Strong personal accountability integrity a commitment to upholding Quantum Healths values ethics and data privacy requirements.

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