OID Exchange Policy & Compliance Director

State of Oklahoma•Oklahoma City, OK

4d•Hybrid

About The Position

DEFINITION: The Policy & Compliance Director reports to the Oklahoma State Based Exchange (Exchange) Executive Director. This role provides strategic leadership for the development and oversight of Exchange policy and compliance functions, ensuring alignment with federal and state requirements and supporting Exchange goals. Exchange staff, including the Policy & Compliance Director, are expected to develop and maintain working knowledge of state and federal Exchange requirements, systems, reporting, and regulations as they relate to their responsibilities. DUTIES AND RESPONSIBILITIES: The Policy & Compliance Director is responsible for establishing and overseeing the Exchange’s policy development, regulatory compliance, and risk management strategy. This role allows Exchange programs to operate in full alignment with federal and state requirements and serves as a primary liaison with CMS as well as OID’s Legal team. The responsibilities of this role include, but are not limited to the following: Lead the development, review, and implementation of Exchange policies, regulations, and procedures. Maintain a centralized Exchange policy manual documenting program policies and procedures. Review and approve policies and business requirements across the Exchange functions. Interpret and apply federal and state laws and regulations governing health insurance Marketplaces, including ACA, CMS guidance, and applicable Oklahoma statutes. Coordinate with OID Legal on Exchange-related legal and policy matters. Oversee Exchange compliance with all applicable federal and state laws, regulations, and contractual obligations. Serve as the primary point of contact with CMS for Exchange related compliance and program integrity activities, including federally required audits. Identify, assess, and mitigate legal and compliance risks. Advise executive leadership on legal exposure, enforcement risk, and compliance strategy. Oversee development and submission of required federal reports. Oversee development and release of any public reporting. Establish and monitor Key Performance Indicators (KPIs) to assess compliance and operational performance. Oversee resolution for escalated compliance issues involving issuers, assisters, agents, brokers, and vendors; coordinate corrective action plans when necessary.

Requirements

Regulatory and policy analysis.
Health policy development.
Compliance monitoring and risk management.
Strategic and analytical thinking.
Governance and accountability.
Ethical judgement.
Juris Doctor (JD) or equivalent legal training, or substantial professional experience working in a legally regulatory environment (minimum 10 years).
Ability to interpret, implement, and oversee compliance with federal and state laws, regulations, and policies.
Familiarity with legal and regulatory processes and the ability to independently interpret and apply statutory and regulatory requirements.
Experience working with health policy, public programs, or regulated industries.
Ability to analyze policy and regulatory requirements and translate them into clear operational guidance and procedures.
Strong program and project management skills, including the ability to set priorities, manage competing deadlines, and ensure accountability.
Exceptional written and verbal communication skills, with the ability to work effectively with leadership, staff, external partners, and oversight entities.
Ability to provide sound legal and policy judgment in a complex, high visibility environment, with executive presence appropriate for a senior leadership role.

Nice To Haves

Understanding of the Affordable Care Act (ACA) and the individual health insurance market, including federal and state health insurance policies, programs, and stakeholders.
Experience working with state or federal health insurance entities.
Licensed attorney in good standing.
Experience with administrative law and rulemaking.

Responsibilities

Lead the development, review, and implementation of Exchange policies, regulations, and procedures.
Maintain a centralized Exchange policy manual documenting program policies and procedures.
Review and approve policies and business requirements across the Exchange functions.
Interpret and apply federal and state laws and regulations governing health insurance Marketplaces, including ACA, CMS guidance, and applicable Oklahoma statutes.
Coordinate with OID Legal on Exchange-related legal and policy matters.
Oversee Exchange compliance with all applicable federal and state laws, regulations, and contractual obligations.
Serve as the primary point of contact with CMS for Exchange related compliance and program integrity activities, including federally required audits.
Identify, assess, and mitigate legal and compliance risks.
Advise executive leadership on legal exposure, enforcement risk, and compliance strategy.
Oversee development and submission of required federal reports.
Oversee development and release of any public reporting.
Establish and monitor Key Performance Indicators (KPIs) to assess compliance and operational performance.
Oversee resolution for escalated compliance issues involving issuers, assisters, agents, brokers, and vendors; coordinate corrective action plans when necessary.