Regulatory Operations Business Analyst III - Healthcare

Centene Corporation

18h

About The Position

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: With the Ambetter Regulatory Operations team, you will perform or assist with regulatory filings for medium/high risk states, seeking annual approval for individual commercial marketplace. Completes Qualified Health Plans (QHP) federal and/or state required application templates and documents for medium/high risk states, including policy forms for individual commercial marketplace products for low-risk states. Guides and conducts special projects; reviews and provides interpretation of application instructions from regulatory agencies (Department of Insurance (DOI) and Centers for Medicare & Medicaid Services (CMS)) and assists in the development of and implementation of auditing and monitoring strategies for medium/high-risk states. Performs root cause analysis to inform continuous improvement and special project development activities. Oversees and prepares Qualified Health Plan templates and/or formal regulatory filing documents, seeking approval of our individual commercial marketplace health plans for Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF)filings for high-risk states. Audits QHP documents for high-risk states ensuring documents are compliant, accurate and align with product intent. Actively manages and collaborates with Sources of Truth (SOT) document owners for Qualified Health Plan (QHP) filing template and policy form development. Continuously supports SOT creation process and audits complex data inputs across SOT documents and/or as determined by DOI and CMS requirements. Attends, engages and represents their Regulatory Operations team in dynamic cross functional meetings to ensure currency of information related to regulatory and/or market landscape. Leads meetings as needed. Collaborates with cross functional teams to ensure QHP filing documents are accurate and align with product intent. Analyzes proposed and/or enacted federal and state legislation and/or regulatory orders. Communicates impacts and/or risks related to their Regulatory Operations team and Reg Ops Cross-departmental functions for advocacy and/or implementation needs. Leads implementation of passed legislation or new regulations impacting Qualified Health Plan (QHP) scope of work and/or related policy forms and filing templates. Takes ownership of, and coordinates team activities for the maintenance, implementation and continuous improvement of department policies, procedures, and work processes to ensure corporate standards are compliant. Assists with managing relationships with regulatory agencies (DOI and CMS). Leads onboarding of new employees and training of analysts on essential job duties; maintains and updates training materials. Coordinates and leads projects internal to the department acting as a subject matter expert for the department. May attend external and/or virtual conferences and seminars to evaluate industry trends. Performs other duties as assigned Complies with all policies and standards

Requirements

Bachelor's Degree Business, Communications, Health Care, Political Science or equivalent experience required
4+ years business process or data analysis experience in health insurance, legal, compliance or related area required

Nice To Haves

Experience in commercial health insurance and/or behavioral health managed care preferred
Experience drafting and auditing filing documentation (Summary of Benefit Coverage, Schedule of Benefits, etc.) or QHP Templates (Plans and Benefit, Pharmacy, Crosswalk, etc.) preferred
Experience auditing database or QHP filing documentation preferred
Knowledge of SERFF and/or HIOS systems preferred

Responsibilities

Perform or assist with regulatory filings for medium/high risk states, seeking annual approval for individual commercial marketplace.
Complete Qualified Health Plans (QHP) federal and/or state required application templates and documents for medium/high risk states, including policy forms for individual commercial marketplace products for low-risk states.
Guide and conduct special projects; review and provide interpretation of application instructions from regulatory agencies (Department of Insurance (DOI) and Centers for Medicare & Medicaid Services (CMS)) and assist in the development of and implementation of auditing and monitoring strategies for medium/high-risk states.
Perform root cause analysis to inform continuous improvement and special project development activities.
Oversee and prepare Qualified Health Plan templates and/or formal regulatory filing documents, seeking approval of our individual commercial marketplace health plans for Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF)filings for high-risk states.
Audit QHP documents for high-risk states ensuring documents are compliant, accurate and align with product intent.
Actively manage and collaborate with Sources of Truth (SOT) document owners for Qualified Health Plan (QHP) filing template and policy form development.
Continuously support SOT creation process and audits complex data inputs across SOT documents and/or as determined by DOI and CMS requirements.
Attend, engage and represent their Regulatory Operations team in dynamic cross functional meetings to ensure currency of information related to regulatory and/or market landscape.
Lead meetings as needed.
Collaborate with cross functional teams to ensure QHP filing documents are accurate and align with product intent.
Analyze proposed and/or enacted federal and state legislation and/or regulatory orders.
Communicate impacts and/or risks related to their Regulatory Operations team and Reg Ops Cross-departmental functions for advocacy and/or implementation needs.
Lead implementation of passed legislation or new regulations impacting Qualified Health Plan (QHP) scope of work and/or related policy forms and filing templates.
Take ownership of, and coordinate team activities for the maintenance, implementation and continuous improvement of department policies, procedures, and work processes to ensure corporate standards are compliant.
Assist with managing relationships with regulatory agencies (DOI and CMS).
Lead onboarding of new employees and training of analysts on essential job duties; maintains and updates training materials.
Coordinate and lead projects internal to the department acting as a subject matter expert for the department.
May attend external and/or virtual conferences and seminars to evaluate industry trends.
Perform other duties as assigned
Comply with all policies and standards