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: Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics. Performs state or federal policy research and regulatory change monitoring with a goal of achieving formal regulatory approval of commercial/Marketplace products.
- Identifies, analyzes and interprets proposed or enacted legislation related to Centene's commercial product at the federal and state level and communicates findings to impacted departments. Independently performs risk assessments, including impact to business applications and downstream output. Maintains database and other reference materials related to legislative and regulatory issues and compliance.
- Performs comprehensive, complex regulatory analyzes, including the review, summarization and dissemination of key regulatory updates and changes related to Commercial/ACA rules and regulations at the state and/or federal level. Leads regulatory interpretation related to Commercial/ACA Rules and regulations and the commercial product explaining concepts clearly and adapting language and presentation based on audience level. Provides advice to business as new regulations emerge.
- Uses persuasive arguments and secures cooperation from the business in order to address potential legal, contractual and/or regulatory issues. Ability to determine appropriate approach for solving regulatory problems.
- Develops trust-based relationships within varied audiences and collaborates with other functional areas to lead large projects and initiatives. Attends cross-departmental meetings as department representative, provides guidance to the business related to commercial regulatory requirements and appropriately escalates matters to management. Solutions to address potential legal, contractual and/or regulatory issues which arise working closely with Legal and Compliance.
- Support and manage relationships between health plans and regulatory agencies, including state and federal regulators. Independently drafts responses to external requests for information required by the organization for its regulatory filings and/or for policy needs.
- Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.
- Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to commercial/ACA filings. Partners on response with cross-functional partners as needed.
- Leads the research and regulatory guardrails for new state entry and new product development, working closely with legal on preparation of COA application materials/submissions for new states and/or products.
- Assists in developing and mentorship of junior employees, supporting creation and revisions to training materials. May attend external and/or virtual conferences and seminars to evaluate industry trends.
- 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 in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required. Master's Degree in a related field or Jurisprudence (JD) preferred
- 4+ years experience in health insurance, legal, compliance or related field required
- Experience reviewing regulations and providing interpretation using terms appropriate for the audience preferred
- Experience in commercial health insurance and/or behavioral health managed care preferred
Pay Range: $67,400.00 - $121,300.00 per year
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
