Senior Regulatory Specialist - Jefferson Health Plan

Thomas Jefferson University•Philadelphia, PA

2d•Onsite

About The Position

The Regulatory Specialist is responsible for ensuring organizational compliance with federal and state regulatory requirements related to Medicare Advantage and ACA-compliant individual and small group health plans. This position plays a critical role in interpreting new and existing regulations, coordinating with internal teams to implement necessary changes, and managing regulatory filings and communications with oversight agencies such as CMS and state Departments of Insurance (DOIs). This position is responsible for monitoring regulatory developments and policy changes, analyzing their impact on business operations, preparing filings, and collaborating with internal stakeholders to operationalize requirements and maintain compliance with CMS and state laws and mandates. The ideal candidate has a strong understanding of health insurance laws (e.g., ACA, HIPAA, CMS, state DOI regulations) and experience working with regulatory bodies.

Requirements

Bachelor’s Degree in public health, Business Administration, Health Policy, Law, or a related field
3 years in a regulatory or compliance role within the health insurance, healthcare, or managed care industry
Strong analytical, research and critical thinking skills.
Excellent written and verbal communication abilities.
Attention to detail and high level of organizational skills.
Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
Proficiency with Microsoft Office Suite.
Comfortable working in a cross-functional and deadline-driven environment.
Knowledge of applicable federal and state health insurance regulations, including ACA, CHIP, HIPAA, Medicare, and Medicaid.
Experience dealing with regulatory agencies such as CMS and state DOIs.
A strong understanding of ACA and Medicare benefits and regulations, including QHP and Medicare Advantage requirements and state/federal Exchange operations.

Nice To Haves

Juris Doctor in a relevant field is a plus
Master’s Degree in a relevant field is a plus
Experience with HPMS, SERFF and HIOS systems is a plus.
Experience preparing or supporting CMS and DOI filings is strongly preferred.

Responsibilities

Monitor federal and state regulatory changes, analyzing operational impact and providing analysis for internal stakeholders, including internal training, dissemination and distribution of regulatory communications to affected business units.
Interpret bid and filing requirements, working with cross-functional teams to advise on implementation of new programs and initiatives.
Prepare and ensure timely and accurate submission of regulatory bid, binder and state filings, license renewals, and responses to state Departments of Insurance (DOIs), Centers for Medicare & Medicaid Services (CMS), and other oversight agencies.
Collaborate with internal departments to ensure product benefits and communication materials meet requirements.
Maintain accurate records of regulatory correspondence, provide distribution to affected departments, and ensure timely follow-up on required actions.
Draft and update compliance policies and procedures specific to regulatory department.
Serve as a subject matter expert (SME) for regulatory requirements and provide training and guidance to internal teams.
Serve as a liaison between the company and regulatory agencies.
Ensure Medicare Advantage plans meet all CMS regulations, including Part C & D requirements, marketing guidelines, network adequacy, and reporting requirements.
Ensure ACA plans meet all state and federal mandates, including QHP certification requirements, essential health benefits, and standardized plan structures.

Benefits

medical (including prescription)
supplemental insurance
dental
vision
life and AD&D insurance
short- and long-term disability
flexible spending accounts
retirement plans
tuition assistance
voluntary benefits
tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service