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Regulatory Operations Analyst III - Member Policy/EOC

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  • Business Area: Legal & Compliance
  • Job Type: Full time
  • Date Posted:
  • Job Number: 1475603
This job is available in 6 locations

Regulatory Operations Analyst III - Member Policy/EOC

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Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Performs or assists with regulatory filings, seeking approval of commercial products for the commercial markets, and/or performs policy research and issue advocacy. Guides special projects; provides regulatory interpretation; and assists in the development of and implementation of auditing and monitoring strategies. Responsible for creation of member policy documents, including Evidence of Coverage, for commercial products for high-risk states. Owns the preparation and filing for new state entry and new product development.

  • Monitors pending legislation and regulations affecting Centene’s commercial product in high-risk states. Analyzes and interprets the proposed or enacted legislation and communicates to impacted departments. Assists partners with implementation of passed legislation or new regulations.
  • Leads managing and supporting successful relationship with regulatory agencies (Department of Insurance and Centers for Medicare & Medicaid Services (CMS)).
  • Assists with onboarding of new employees and training of analysts on essential job duties; maintains and updates training materials.
  • Oversees and prepares formal regulatory filings, seeking approval of our commercial health plans within Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF) for high-risk states.
  • Creates and audits member policy documentation, including Evidence of Coverage and related documents, for high-risk states.
  • Creates and audits Qualified Health Plan (QHP) templates for high-risk states.
Education/Experience: Bachelor’s degree in Business, Communications, Healthcare, Political Science/ Pre-Law or equivalent experience. 4+ years of experience in health insurance, legal, or compliance required. Experience in commercial health insurance and/or behavioral health managed care. Knowledge of SERFF and HIOS preferred. Experience drafting and auditing policy documentation or QHP Templates preferred. Experience auditing database or documentation preferred.Pay Range: $66,100.00 - $118,900.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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