SUBJECT MATTER EXPERT

Healthcare Management Solutions LLC • Fairmont, WV

6d

About The Position

We are seeking a knowledgeable and experienced Subject Matter Expert (SME) to support the operational, regulatory, and compliance functions of the FFE. This role supports oversight activities for health insurance issuers, web‑brokers, agents/brokers, and Direct Enrollment (DE/EDE) entities participating in the Health Insurance Marketplace.

The SME provides high‑level expertise in ACA Marketplace policy, issuer compliance, audit support, data interpretation, and operational guidance. This position is ideal for an experienced professional with deep understanding of Exchange operations and federal oversight requirements.

Requirements

• Significant state regulatory experience, preferably in the field of insurance;
• Ability to lead the communications with State DOIs and issuers;
• Knowledge of the insurance industry, preferably the health insurance industry
• Experience: At least 5 years of experience related to areas noted above, or a combination of education and equivalent work experience;
• Education: A Master’s degree in public policy, information management, statistics, business, or related fields or equivalent combination of education and experience.

Responsibilities

• Serve as the lead expert on Affordable Care Act (ACA) Marketplace requirements, including QHP issuer rules, broker/web‑broker participation standards, and FFE operational processes.
• Provide guidance on compliance oversight, corrective action planning, enforcement processes, and program integrity activities.
• Support Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE) program operations, including audit requirements, readiness reviews, privacy standards, and website/eligibility process evaluations.
• Interpret complex regulatory and operational guidance and translate requirements into actionable recommendations for project teams and stakeholders.
• Contribute expert insights to data analysis activities, issuer performance monitoring, risk assessments, and compliance trend evaluation.
• Review and refine operational policies, SOPs, training materials, technical guidance, templates, and other program documents.
• Participate in stakeholder engagements, including collaboration with internal CMS teams, state regulators, and external partners.
• Assist in preparing training, briefings, and communications to support program operations and compliance understanding.
• Ensure all recommendations and materials align with federal security, privacy, and data‑handling standards.

What This Job Offers

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