Remote Integrity Investigator Jobs in Ohio (NOW HIRING)

Who we are  

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re 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 – that’s why we call ourselves Healthcare Warriors®.   

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t 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 you’ll 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 you’ll 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 Health’s values, ethics, and data privacy requirements.

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