Description:

About the role:
The Associate General 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.

What You'll Do:

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 you'll bring

Education: Juris Doctor (J.D.) from an accredited law school.
Licensure/Certifications: Active license to practice law in a U.S. state.
7+ 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.
A high degree of personal accountability and trustworthiness, a commitment to working within An Award-Winning Consumer Healthcare Navigation Company's policies, values and ethics, and to protecting the sensitive data entrusted to us.

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What's in it for you

Compensation: Competitive base and incentive compensation
Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!

What you should know:

Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check.
Diversity, Equity and Inclusion: An Award-Winning Consumer Healthcare Navigation Company welcomes everyone. We value our diverse team and suppliers, we're committed to empowering our ERGs, and we're proud to be an equal opportunity employer . (https://quantum-health.com/diversity-equity-inclusion/)
Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, An Award-Winning Consumer Healthcare Navigation Company maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.
Compensation Ranges: Compensation details published by job boards are estimates and not verified by An Award-Winning Consumer Healthcare Navigation Company. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate's unique combination of experience and qualifications related to the position.
Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
Agencies: An Award-Winning Consumer Healthcare Navigation Company does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.