Position Purpose: Performs or assists with regulatory filings for medium/high risk states, seeking annual approval for individual commercial marketplace. Completes Qualified Health Plans (QHP) federal and/or state required application templates and documents for medium/high risk states, including policy forms for individual commercial marketplace products for low-risk states. Guides and conducts special projects; reviews and provides interpretation of application instructions from regulatory agencies such as Department of Insurance (DOI) and Centers for Medicare & Medicaid Services (CMS) and assists in the development of and implementation of auditing and monitoring strategies for medium/high-risk states. Performs root cause analysis to inform continuous improvement and special project development activities.
Key Details: The role is fully remote within the continental United States. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
- Oversees and prepares 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 high-risk states.
- Audits QHP documents for high-risk states ensuring documents are compliant, accurate and align with product intent.
- Actively manages and collaborates with Sources of Truth (SOT) document owners for Qualified Health Plan (QHP) filing template and policy form development. Continuously supports SOT creation process and audits complex data inputs across SOT documents and/or as determined by DOI and CMS requirements.
- Attends, engages and represents their Regulatory Operations team in dynamic cross functional meetings to ensure currency of information related to regulatory and/or market landscape. Leads meetings as needed. Collaborates with cross functional teams 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. Communicates impacts and/or risks related to their Regulatory Operations team and Reg Ops Cross-departmental functions for advocacy and/or implementation needs.
- Leads implementation of passed legislation or new regulations impacting Qualified Health Plan (QHP) scope of work and/or related policy forms and filing templates.
- Takes ownership of, and coordinates team activities for the maintenance, implementation and continuous improvement of department policies, procedures, and work processes to ensure corporate standards are compliant.
- Assists with managin