Associate, Exchange Compliance

Oscar Health•Tempe, AZ

3d•Hybrid

About The Position

The Associate, Exchange Compliance, will lead operations and foster relationships with regulators, including operational and technical staff at state-based insurance exchanges and with CMS. You will bridge the gap between regulators and Oscar operations to ensure regulatory changes and operational adjustments are implemented and monitored. You will ensure Oscar complies with all industry specifications, standards, regulations, and laws. You will review operational practices, create and enforce policies & procedures, and perform regulatory reviews. You will ensure and enforce Oscar's compliance with external exchange operations. You will report into the Manager, State Based Exchanges.

Requirements

Bachelor's Degree or equivalent work experience
1+ year experience in health plan compliance
2+ years experience with State DOI health insurance rules and regulations, CMS ACA rules and requirements, CMS requirements
2+ years experience managing high volume and complicated projects, keeping track of details, and staging work to deliver projects on time

Nice To Haves

CHC, CCEC, or similar
Fluency with State DOI audit and/or reporting obligations
State DOI audit management experience
Experience in a start-up and/or health tech environment
Experience in a TPA setting
Experience with state-based exchanges and the federally facilitated marketplace
Experience improving and designing processes
Experience attending external meetings with key regulatory staff
Experience presenting complex concepts to Senior Level staff for business decisions

Responsibilities

Partner with all relevant departments to make sure current compliance levels.
Provide training to team members regarding regulatory compliance.
Ensure that all team members are aware of the procedures to be followed to follow compliance requirements.
Develop and implement compliance improvement plans where required.
Delegate tasks to other departments to bring compliance levels up.
Develop reports, where necessary, to the governing body.
Assist Regulatory Authorities with completing site visits and external audits.
Prepare for, and conduct audits alongside external authorities.
Conduct regular audits in all required areas to make sure compliance levels.
Support account management for Oscar's CMS and state-based exchange regulators, and manage main technical and operational action items to ensure compliance.
Escalate complex operational and technical issues and questions to regulators while maintaining compliance and preserving Oscar's reputation.
Be the lead contact for Oscar on all exchange calls and requests.
Help build a standard set of processes for teams to track dependencies, deliverables, and product/feature launches.
Work collaboratively with multiple teams
Compliance with all applicable laws and regulations
Other duties as assigned