Centene - Austin, TX
posted 4 months ago
Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, we are seeking a dedicated individual to perform or assist with regulatory filings for medium/high risk states, aiming for annual approval for individual commercial marketplace health plans. This role involves completing Qualified Health Plans (QHP) federal and/or state required application templates and documents, particularly for medium/high risk states, and includes policy forms for individual commercial marketplace products for low-risk states. The successful candidate will guide and conduct special projects, review and interpret application instructions from regulatory agencies such as the Department of Insurance (DOI) and the Centers for Medicare & Medicaid Services (CMS), and assist in developing and implementing auditing and monitoring strategies for these states. In this position, you will oversee and prepare Qualified Health Plan templates and formal regulatory filing documents, seeking approval for our individual commercial marketplace health plans through the Health Insurance Oversight System (HIOS) and the System for Electronic Rates & Forms Filing (SERFF) for high-risk states. You will audit QHP documents to ensure compliance, accuracy, and alignment with product intent. Collaboration is key, as you will actively manage and work with Sources of Truth (SOT) document owners for QHP filing template and policy form development, continuously supporting the SOT creation process and auditing complex data inputs as required by DOI and CMS. You will also represent the Regulatory Operations team in cross-functional meetings, ensuring the currency of information related to regulatory and market landscapes, and lead meetings as necessary. Analyzing proposed and enacted federal and state legislation and regulatory orders will be part of your responsibilities, as you communicate impacts and risks to your team and other departments for advocacy and implementation needs. Additionally, you will lead the implementation of new regulations impacting QHP scope of work and related policy forms and filing templates. Ownership of team activities for the maintenance, implementation, and continuous improvement of department policies, procedures, and work processes is essential to ensure compliance with corporate standards. You will assist in managing relationships with regulatory agencies and lead the onboarding and training of new employees, maintaining and updating training materials. This role may also involve coordinating and leading internal projects, acting as a subject matter expert for the department, and performing other duties as assigned while complying with all policies and standards.