Regulatory Operations Business Analyst III

Centene Corporation•Remote-MO, MO

1d•$70,100 - $126,200•Remote

About The Position

Performs or assists with regulatory filings for medium- and high-risk states, seeking annual approval for individual commercial marketplace products. Completes Qualified Health Plan (QHP) federal and state application templates and documents for medium- and high-risk states, including policy forms for individual commercial marketplace products in low-risk states. Guides special projects, interprets application instructions from regulatory agencies such as state Departments of Insurance (DOI) and the Centers for Medicare & Medicaid Services (CMS), and assists in developing and implementing auditing and monitoring strategies. Performs root cause analysis to inform continuous improvement and special project development. The role oversees and prepares QHP templates and formal regulatory filing documents for Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF) submissions in high-risk states. It audits QHP documents for compliance, accuracy, and alignment with product intent; works with Sources of Truth document owners; and audits complex data inputs across documents and in response to agency requirements. The analyst represents Regulatory Operations in cross-functional meetings, analyzes legislation and regulatory orders, communicates impacts and risks, and leads implementation of changes affecting QHP work and related policy forms and filing templates. The position coordinates maintenance and continuous improvement of department policies, procedures, and work processes; assists with regulatory agency relationships; leads employee onboarding and analyst training; and coordinates internal department projects as a subject matter expert. The analyst may attend external or virtual conferences and seminars to evaluate industry trends, and performs other assigned duties while complying with applicable policies and standards. This position is fully remote within the continental United States. Applicants must be authorized to work in the U.S. without current or future employment-based visa sponsorship. The stated pay range is $70,100 to $126,200 per year, with actual pay adjusted for relevant factors. Centene describes its work as supporting access to healthcare and improving the health of individuals, families, and communities.

Requirements

Bachelor's degree in Business, Communications, Health Care, Political Science, or equivalent experience.
At least 4 years of business process or data analysis experience in health insurance, legal, compliance, or a related area.
Must be authorized to work in the United States without the need for current or future employment-based visa sponsorship.

Nice To Haves

Experience in commercial health insurance and/or behavioral health managed care.
Experience drafting and auditing filing documentation, such as Summary of Benefit Coverage or Schedule of Benefits, or QHP templates, such as Plans and Benefit, Pharmacy, or Crosswalk.
Experience auditing databases or QHP filing documentation.
Knowledge of SERFF and/or HIOS systems.

Responsibilities

Oversee and prepare QHP templates and formal regulatory filing documents for HIOS and SERFF filings in high-risk states.
Audit QHP documents for compliance, accuracy, and alignment with product intent.
Manage collaboration with Sources of Truth document owners and support creation and auditing of QHP filing templates, policy forms, and complex data inputs.
Participate in and represent Regulatory Operations in cross-functional meetings; lead meetings as needed and collaborate to ensure filing documents are accurate and align with product intent.
Analyze proposed or enacted federal and state legislation and regulatory orders, and communicate impacts and risks to Regulatory Operations and cross-departmental functions.
Lead implementation of legislation and regulations affecting QHP work, policy forms, and filing templates.
Coordinate maintenance, implementation, and continuous improvement of department policies, procedures, and work processes.
Assist with relationships with DOI and CMS.
Lead onboarding of new employees and training of analysts; maintain and update training materials.
Coordinate and lead internal department projects, serving as a subject matter expert.
Attend external or virtual conferences and seminars as needed to evaluate industry trends.
Perform other assigned duties and comply with policies and standards.