Regulatory Analyst

Moda Health•Portland, OR

1d•Hybrid

About The Position

The Regulatory Analyst reviews and analyzes new and existing laws, regulations, and policies to determine their impact on commercial group and individual health and dental insurance plans, as well as self-funded plans. This role is responsible for managing policy documents, certificates of coverage, and other regulatory filings, and supports the organization’s compliance with regulatory requirements. The position facilitates adherence to state and federal regulations, internal processes, and filed documents. The Regulatory Analyst also drafts and reviews filed materials and internal documents to ensure alignment with state, federal, and organizational standards; prepares and submits required filings and reports; and serves as a liaison to internal departments and state and federal regulators. This is a FT WFH position.

Requirements

Bachelor’s degree or at least 3-5 years of experience in the health insurance industry required, including experience in contract drafting and interpretation or regulatory filings.
At least two years of experience in regulatory compliance, drafting contracts, contract interpretation and submission of required filings, or equivalent experience preferred.
Ability to work and think independently in researching, analyzing, interpreting, and disseminating information about complex insurance law and contracts.
Ability to identify areas of compliance concern and develop recommendations for resolving compliance issues.
Ability to advise and direct all departments, including senior and executive positions, on the interpretation and implementation of regulatory requirements and contracts.
Strong audit skills to provide regulatory feedback on any subject matter from internal departments, including the ability to compare multiple documents and trouble shoot problems.
Ability to organize and prioritize large workloads with competing demands in an efficient and timely manner.
Detail oriented with good organizational and problem-solving skills.
Strong and effective verbal and written communication skills.
Ability to maintain confidentiality and project a professional business image.
Computer proficiency with Microsoft Office applications, Adobe Acrobat and internet research.
Ability to come into work on time and daily.
A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
Must be comfortable being on camera for virtual training and meetings.

Nice To Haves

At least two years of experience in regulatory compliance, drafting contracts, contract interpretation and submission of required filings, or equivalent experience preferred.

Responsibilities

Prepare and file annual form filings with the State Insurance Divisions and CMS, including initial filings, amendments, and required responses to regulator requests or questions.
Research and interpret compliance requirements, including state and federal laws and regulations, and apply knowledge to company operational issues.
Review marketing materials, plan change notices, and other regulated communications for compliance.
Collaborate with other departments within the organization regarding compliance with contracts and state and federal regulations, including effective communication and education about state and federal regulations, implementation of benefit changes and process and procedure changes.
Evaluate sufficiency of, and interpret, contract benefits based on insurance law and internal standards and policies.
Assist with daily question workload regarding federal and state rules and regulations.
Review internal and external documents and content, including Request for Proposal responses, for compliance.
Maintain a tracking system to retain historical information on benefit, contract, and regulatory interpretations to ensure accurate and consistent treatment.
Work with Contract Services in the production of contracts after State approval.
Audit internal departments for contract and regulatory compliance.
Perform other duties as assigned.