You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.
Position Purpose: Completes Qualified Health Plans (QHP) federal and/or state required application templates and documents for medium risk states, including policy forms for individual commercial marketplace products for medium-risk states. Conducts assigned special projects, implements provided interpretation of application instructions from regulatory agencies (Department of Insurance (DOI) and Centers for Medicare & Medicaid Services (CMS)) and performs associated reporting, analysis and quality assurance tasks for medium/low-risk states.
- Completes Qualified Health Plan templates and/or formal regulatory filing documents, seeking approval of our individual commercial marketplace health plans for Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF) filings for medium/low-risk states, ensuring quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements.
- Audits all QHP documents for medium-risk states ensuring quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements.
- Performs data entry and/or audits across Source of Truth (SOT) documents used for QHP filing and policy form development and/or as determined by CMS and DOI requirements. SOT is relied on by numerous cross functional teams for benefit and cost share information which is utilized in public and member facing documents.
- Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.
- Attends, and engages as a subject matter expert in dynamic cross functional meetings to provide other departments with information related to regulatory and/or market landscape which is used to inform business decisions Collaborates with cross functional teams as a subject matter expert to ensure QHP filing documents are accurate and align with product intent.
- Analyzes proposed and/or enacted federal and state legislation and/or regulatory orders to determine impacts to QHP and regulatory filing documents. Communicates impacts and/or risks related to their functional responsibility which is utilized for advocacy and implementation needs. Supports implementation of new regulations/legislation impacting QHP scope of work and performs updates to policy and filing documents related to implementation.
- Participates in the maintenance, implementation and continuous improvement of department policies, procedures, and work processes to ensure corporate standards are compliant.
- Participates in managing relationships with regulatory agencies (DOI and CMS). Attends calls with regulators discussing QHP filing documents and performs updates to materials based on regulator feedback, drafts appropriate responses to regulator inquiries.
- Participates in onboarding of new employees and training of analysts on essential job duties; maintains and updates training materials.
- May attend external and/or virtual conferences and seminars to evaluate industry trends.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
- Bachelor's Degree Business, Communications, Health Care, Political Science, related field or equivalent experience required.
- 2+ years regulatory experience, including business process or data analysis experience in health insurance, legal, or regulatory compliance required
- 2+ years experience in commercial health insurance and/or behavioral health managed care preferred
- 2+ years knowledge of SERFF and/or HIOS systems preferred
Pay Range: $25.97 - $46.68 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
