Senior Consultant - Public Health - Healthcare Review/Audit Policy
About The Position
The Healthcare Review/Audit Policy Member is responsible for monitoring federal/state policy changes and court rulings relevant to the Exchanges (e.g., changes impacting the Advanced Premium Tax Credit (APTC)/Qualified Health Plan (QHP) eligibility, and Special Enrollment Periods (SEPs)). This is achieved through reviewing annual Exchange regulations, sub-regulatory guidance, and system/operations documentation. The role assesses the impact of those changes on the Exchange Improper Payment Measurement (EIPM) methodology, including review unit logic, scripts, and review tools, and determines where updates are required. The position develops policy update deliverables and coordinates with technical, review, and data teams to accurately reflect changes.
Requirements
- Bachelor’s degree
- 3-5+ years of relevant experience
- Experience working in or knowledge of the Affordable Care Act, specifically State-Based Exchanges, Federally-Facilitated Exchanges, and health insurance markets and exchanges
- Ability to oversee multiple concurrent workstreams
- Excellent communication skills (verbal and written)
- Strong stakeholder management skills and experience
- Ability to Obtain Public Trust clearance
Nice To Haves
- Experience with regulatory analysis
- Ability to navigate ambiguity and provide clear guidance, direction, and structure to the team
- Flexibility and agility to respond to changing requirements in a dynamic environment
- Skills to develop training on regulatory updates and train team members on the impact of the changes
- Proficiency working with compliance team members and developers to confirm that regulatory changes are properly reflected in testing methodology and automation scripts
Responsibilities
- Monitoring federal/state policy changes and court rulings relevant to the Exchanges.
- Assessing the impact of policy changes on Exchange Improper Payment Measurement (EIPM) methodology.
- Determining where updates are required for review unit logic, scripts, and review tools.
- Developing policy update deliverables.
- Coordinating with technical, review, and data teams to accurately reflect changes.
Benefits
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Discretionary variable incentive bonus
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
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What This Job Offers
Job Type
Full-time
Career Level
Senior
