Senior Insurance Product Compliance Professional

Humana

1d • $78,400 - $107,800 • Remote

About The Position

The Senior Insurance Product Compliance Professional negotiates with state and federal regulatory agencies to secure approval for insurance policies and certificates. This role supports the implementation and ongoing maintenance of compliant insurance policy and certificate documentation. It also contributes to departmental strategy and exercises sound judgment in determining how to manage technical work for complex project components. The Senior Insurance Product Compliance Professional Negotiates with state and federal regulatory agencies to obtain policy and certificate approval for insurance products. They support implementation and maintenance of compliant insurance policies and certificates. They contribute to department strategy and make decisions on how to handle technical work for complex project components. They work independently and exercise latitude in determining objectives and approaches to assignments.

Requirements

• Bachelor's Degree or equivalent experience in a healthcare/insurance compliance function
• Minimum 5 years of healthcare / insurance industry experience
• Knowledge of laws and regulations governing the healthcare / insurance industry experience, such as state Departments of Insurance and CMS
• Ability to research and analyze state laws and regulations
• Understanding of insurance products, including policy/certificate language
• Proficient in Adobe Acrobat and Microsoft 365 (Office) applications, including Word, Excel, Teams, and SharePoint
• Excellent oral and written communication skills. This includes ability to collaborate effectively with associates across all levels of the organization and reviewer-level state/federal regulators
• Demonstrated attention to detail and accuracy
• Proven analytical and problem-solving ability
• Self-motivated and task oriented, with an ability to manage multiple priorities and work under pressure to meet deadlines

Nice To Haves

• Experience with filings in System for Electronic Rate and Form Filing (SERFF)
• Experience developing and filing contract language for supplemental health products, such as hospital indemnity, critical illness, accident, disability income.

Responsibilities

• Develop and maintain group policy and certificate language to support product initiatives, administrative practices, and applicable regulatory requirements.
• Create awareness of current regulatory issues and ensure policy and certificate forms for the company's life, ancillary, and supplemental health insurance products remain compliant with applicable requirements.
• Monitor and analyze regulatory requirements to assess insurance contract language impacts and provide consultative guidance to team members.
• Develop and maintain self-funded group contract templates (Plan Management Agreement and Summary Plan Description) for assigned product(s).
• Facilitate discussions with operational and compliance partners to review and finalize drafted contract language or assist with negotiating regulatory approvals.
• Prepare standard policy and certificate forms for use as templates for state and federal regulatory filings and subsequent implementation.
• Research and develop written responses or provide consultative support for regulatory objections, exams, and inquiries.
• Maintain accurate and thorough documentation, including rationale for new or revised contract language, work instructions, and project tracking information.
• Conduct quality reviews to ensure accuracy and compliance of generic and state-specific policy/certificate forms, advertisements, and other assigned materials.
• Recommend and support process improvements to maximize efficiency.
• Research and provide timely impact responses to Request for Proposals (RFPs) and/or Pre-sale Quotes (PSQs), draft, file and implement contract language to support client needs.
• Serve as Subject Matter Expert (SME) for assigned product lines. This involves responding to policy and certificate language questions, collaborating with cross-functional teams on regulatory impacts, and providing training and support to associates as needed.
• Conduct and/or assist with research regarding contract language or competitor filings and provide findings (as assigned).

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree