Centene Corporation

Transforming the health of the communities we serve, one person at a time.

Regulatory Operations Business Analyst III – Healthcare

Business AnalystBusiness AnalystFull TimeRemoteTeam 10,001+Since 1984H1B No SponsorCompany SiteLinkedIn

Location

California + 4 moreAll locations: California, Illinois, Michigan, Missouri, Texas

Posted

7 days ago

Salary

$70.1K - $126.2K / year

Bachelor Degree4 yrs expEnglish

Job Description

• Perform or assist 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 • Guides and conducts special projects; reviews and provides interpretation of application instructions from regulatory agencies (Department of Insurance (DOI) and Centers for Medicare & Medicaid Services (CMS)) • 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 • Oversees and prepares Qualified Health Plan templates and/or formal regulatory filing documents 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 • Leads meetings as needed; collaborates with cross functional teams to ensure QHP filing documents are accurate • 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

Job Requirements

  • Bachelor's Degree Business, Communications, Health Care, Political Science or equivalent experience required
  • 4+ years business process or data analysis experience in health insurance, legal, compliance or related area required
  • Experience in commercial health insurance and/or behavioral health managed care preferred
  • Experience drafting and auditing filing documentation (Summary of Benefit Coverage, Schedule of Benefits, etc.) or QHP Templates (Plans and Benefit, Pharmacy, Crosswalk, etc.) preferred
  • Experience auditing database or QHP filing documentation preferred
  • Knowledge of SERFF and/or HIOS systems preferred

Benefits

  • competitive pay
  • health insurance
  • 401K and stock purchase plans
  • tuition reimbursement
  • paid time off plus holidays
  • flexible approach to work with remote, hybrid, field or office work schedules

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