Regulatory & Provider Network Filing Analyst

MedPro Group

1d • $60,000 - $80,000 • Onsite

About The Position

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace. Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market. The Regulatory & Provider Network Filing Analyst is responsible for preparing and submitting Wellfleet's student health insurance network filings and reports. This role involves ensuring that regulatory submissions are timely, complete, and accurate. The position requires oversight and coordination with internal and external stakeholders and the ability to understand and apply relevant laws and regulations.

Requirements

• Bachelor’s degree in healthcare administration or related field, and 2+ years of health insurance experience, or a combination of education and experience
• Ability to work effectively with internal and external stakeholders
• Ability to interpret and apply state and federal laws and regulations
• Excellent written communication and interpersonal skills
• Strong organizational skills and the ability to manage competing priorities
• Proficiency with MS Office products including Outlook, Word and Excel
• Demonstrates a strong commitment to compliance and ethics.
• Self-motivated with the ability to work independently, with very little supervisory direction.

Nice To Haves

• Compliance and/or network experience preferred
• SERFF filing system experience preferred
• Familiarity with provider network regulations, accreditation requirements, and NCQA standards preferred

Responsibilities

• Serve as a subject matter expert (SME) in provider network regulations, accreditation requirements, network adequacy standards, and other new and existing laws pertaining to provider networks, guiding and advising across various business areas and activities, including internal and external stakeholders.
• Implement and enforce best practices and policies, ensuring alignment with department and organizational goals.
• Perform a detailed review of new legal and regulatory guidance to identify and implement any necessary changes.
• Track regulatory submission deadlines, and proactively coordinate with external and internal stakeholders to prepare filings in advance of deadlines.
• Oversee network filings and reports from inception to completion, ensuring that all submissions are accurate, well-written, and timely.
• Regularly monitor open submission to ensure timely and accurate responses to any objections or requests for additional information.
• Support the review and development of written responses for network submissions and responses to objections, as needed, and validate data to ensure accurate reporting.
• Ensure all regulatory filings and reporting deadlines are met.
• Implement and enforce best practices and assist with ad hoc projects to achieve departmental or organizational goals.
• Collaborate with internal and external stakeholders to perform network oversight, and develop and monitor corrective action plans, as needed.
• Perform other duties as assigned.

Benefits

• life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level