A Benefits-Online benefit Consultant will assist in developing and maintaining an employee health and welfare benefit plan that is balanced between cost and coverage. These services are performed on an:
Analyze existing plan design
Advise of any desirable shift in emphasis in benefits that arise as medical care, delivery systems and patterns of practice change.
Monitoring utilization trends, calculate benefit costs by line, compare to industry figures, and recommend changes in benefits and cost implication.
Advise on any desirable changes in eligibility rules and periodically determine whether eligibility rules are appropriate as needed.
Assess and monitor fund assets and income to meet the obligations of the plan.
Evaluate claims experience
Prepare and evaluate claims lag studies and incurred claims liability
Project inflation and utilization trends, advise on reserve policies and reserve levels for each benefit
Prepare reports of plan funding status and plan experience
ANALYSIS OF RATE RENEWAL ACTION
Determine appropriate levels of risk to either retain or layoff (self -fund vs. insured risk, stop loss policy). Calculate cost of specific benefits that may be considered.
Coordinate procedures for handling claims disputes
Advise on recommended guidelines for claims which are appealed
Advise on Usual and Customary guidelines and procedures
Review large claims and recommend action as appropriate, advise on plan interpretation and administration.
Review Summary Plan Description, revise as necessary
Prepare all announcements of plan changes of either benefits or eligibility. Prepare Summary Annual Report
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