Responsibilities
- Creates member contract documents such as Evidence of Coverage and related materials for commercial health plans in high-risk jurisdictions.
- Conducts independent research on regulatory and operational requirements affecting Evidence of Coverage and benefit design.
- Evaluates risks associated with changes in legislation and regulations, assessing impact on contract documentation and downstream systems.
- Analyzes Ambetter and commercial Evidence of Coverage documents for accuracy, compliance, and alignment with state, federal, and internal standards.
- Drafts revised language for regulatory documents like EOC, collaborating with legal, compliance, and operations teams for approval.
- Provides expert guidance on health insurance regulations and product structures, advising on necessary updates due to legislative changes.
- Supports professional growth of junior staff and maintains current training resources, policies, and work procedures.
- Interprets federal and multi-state regulatory requirements specific to the commercial health insurance sector.
- Prepares and updates regulatory filings including EOC, checklists, outlines of coverage, enrollment forms, and coverage notices.
- Coordinates EOC review sessions with internal stakeholders to finalize language revisions and resolve contractual concerns.
- Communicates complex information clearly across departments, building consensus and addressing potential obstacles proactively.
- Responds to regulator inquiries on filing submissions, coordinating with cross-functional teams to ensure accurate and compliant answers.
- Reviews benchmark plan data such as essential health benefits and state mandates to inform updates in contractual language.
- Reviews and approves member-facing materials from other departments to ensure consistency in messaging and product representation.
- Maintains awareness of interdepartmental workflows and operational dependencies to support effective project leadership.
- May participate in industry events to stay informed about emerging trends in healthcare regulation and product design.
- Performs additional assigned tasks as needed.
- Adheres to all organizational policies and compliance standards.
Compensation
$70,100.00 - $126,200.00 per year
Work Arrangement
Hybrid
Other
- Pay Range: $70,100.00 - $126,200.00 per year
- Complies with all policies and standards.
