Centene

posted 4 months ago

Full-time - Mid Level
Ambulatory Health Care Services

About the position

As a Regulatory Operations Analyst II - Member Contracts at Centene, you will play a crucial role in transforming the health of our communities by ensuring compliance with state and federal regulations. This position involves performing in-depth policy research and monitoring regulatory changes to achieve formal regulatory approval for commercial and Marketplace products. You will act as a subject matter expert, providing regulatory interpretation to various business units and assisting with special projects and reporting functions. Your ability to understand departmental needs and inter-dependencies with other departments will be essential in this role. In this position, you will monitor pending legislation and regulations that impact Centene's commercial business, particularly in low to medium risk states. Your responsibilities will include analyzing and interpreting proposed or enacted legislation, preparing communications related to these findings, and collaborating with other departments to resolve policy issues that may negatively affect member services. You will conduct research projects to analyze legal, contractual, and regulatory requirements, and communicate these requirements to both internal and external clients. Building trust-based relationships and collaborating with various functional areas will be key to your success. You will lead sub-projects and smaller initiatives, assist teams in addressing potential legal and regulatory issues, and review filing documentation to ensure compliance with regulatory requirements. Additionally, you will manage relationships with regulatory agencies and respond to inquiries from both internal and external stakeholders. Your role will also involve maintaining departmental policies, procedures, and work processes, as well as performing data entry into tracking systems for regulatory and legislative activities.

Responsibilities

  • Perform state or federal policy research and regulatory change monitoring to achieve formal regulatory approval of commercial/Marketplace products.
  • Provide regulatory interpretation to the business as a subject matter expert on various topics.
  • Assist with assigned special projects and perform or support various reporting functions.
  • Monitor pending legislation and regulations affecting Centene's commercial business in low to medium risk states.
  • Analyze, interpret, oversee, and prepare communications related to proposed or enacted legislation and communicate findings to impacted departments.
  • Resolve policy issues that may negatively impact service to members in collaboration with other departments.
  • Conduct research projects to analyze, interpret, and disseminate guidance on legal, contractual, and regulatory requirements for assigned states or subject matter expert areas.
  • Communicate state and federal requirements to internal and external clients.
  • Develop trust-based relationships and collaborate with other functional areas to collect information and follow up for project deliverables.
  • Lead sub-projects and smaller initiatives.
  • Assist internal and external teams regarding solutions to address potential legal, contractual, and/or regulatory issues.
  • Review filing documentation and perform quality assurance review on member documentation relating to regulatory requirements.
  • Assist health plans in managing relationships with regulatory agencies, including state and federal regulators.
  • Respond to internal and external requests and inquiries for information, including from regulatory bodies.
  • Assist in the maintenance and implementation of department policies, procedures, and work processes.
  • Perform data entry into Source of Truth used in departmental tracking of regulatory/legislative activity.

Requirements

  • Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law, MA/JD or equivalent experience required.
  • 2+ years experience in health insurance, legal, or compliance, health policy, or public administration required.
  • 2+ years working knowledge of health insurance products, and state and federal insurance regulations required.
  • 2+ years experience in commercial health insurance and/or behavioral health managed care preferred.

Benefits

  • Competitive pay
  • Health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible work schedules including remote, hybrid, field, or office work options
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