Legal Counsel Sr

Amerihealth Caritas•,

2d•Remote

About The Position

This Senior Legal Counsel role provides strategic legal counsel and regulatory guidance for the Company’s Exchange Marketplace business. The position partners closely with business and functional leaders to interpret regulatory requirements, assess legal and operational risks, and develop practical, business-oriented solutions. The role requires the ability to translate complex legal and regulatory concepts into clear, actionable guidance for executives and operational stakeholders and to influence outcomes effectively in a highly matrixed environment. Standard Legal Counsel, Sr. Summary: Provides strategic legal counsel and recommendations on complex legal matters. Applies established legal standards to protect the organization’s interests and reputation and support compliance with applicable laws and regulations. Advises business and functional leaders to help ensure that activities, policies, business practices, and transactions align with legal and regulatory requirements. Counsels senior management on legal issues and proposed regulatory changes. Demonstrates advanced knowledge in specialized legal disciplines and a strong understanding of the business, healthcare industry, and strategic context.

Requirements

Juris Doctorate (JD) degree from an accredited law school.
Active bar membership in good standing.
Minimum of eight (8) years of legal experience supporting managed care organizations, including substantial experience advising Exchange Marketplace business operations required.
Exceptional ability to synthesize complex legal and regulatory requirements into concise recommendations that support executive decision-making.
Demonstrates strong judgment, intellectual rigor, and the ability to independently manage complex matters in a fast-paced and evolving regulatory environment.
Proven ability to identify, assess, and communicate legal, regulatory, operational, and reputational risks.
Ability to work independently, manage competing priorities, and deliver practical, solution-oriented legal advice with limited oversight.

Responsibilities

Advise business leaders and cross-functional stakeholders on legal and regulatory requirements applicable to the Exchange Marketplace business and other impacted health insurance products.
Interpret federal and state laws, regulations, and agency guidance and provide practical, business-focused legal advice.
Analyze emerging legislative and regulatory developments and communicate resulting legal, operational, and business impacts.
Develop clear recommendations that support informed business decisions while managing legal and regulatory risk.
Identify, evaluate, and communicate legal, regulatory, operational, and reputational risks associated with proposed business activities and strategic initiatives.
Assess risks based on severity, likelihood, business impact, and risk tolerance, and recommend mitigation strategies.
Exercise sound judgment in balancing legal requirements, operational realities, member experience, and business objectives.
Support resolution of complex legal and regulatory issues through practical and risk-balanced recommendations.
Partner with operations, compliance, network, finance, actuarial, government affairs, risk adjustment, sourcing and other business functions to support strategic initiatives and ongoing operations.
Provide timely, solution-oriented legal counsel in support of product implementation, operational changes, regulatory requirements, member initiatives, and business process improvements.
Influence and collaborate with stakeholders across a matrixed organization without direct reporting authority.
Translate complex legal issues into clear, concise guidance tailored to executive, operational, and technical audiences.
Support implementation of new laws, regulations, and regulatory guidance affecting the Exchange Marketplace line of business.
Collaborate with business stakeholders to identify operational impacts and develop compliant implementation strategies.
Assist in the development, review, and enhancement of policies, procedures, communications, and business practices to support regulatory compliance.
Support special projects, regulatory inquiries, audits, examinations, and other legal matters as assigned.
Contribute to departmental initiatives designed to improve legal service delivery, operational efficiency, and business partnership.