Regulatory Operations Analyst II - Member Contracts

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: Performs state or federal policy research and regulatory change monitoring, with an goal of achieving formal regulatory approval of commercial/Marketplace products. Provides regulatory interpretation to the business as a subject matter expert on various topics. Assist with assigned special projects and performs or supports various reporting functions. Ability to understand the needs of the Department and inter-dependencies with other departments. Supports research and regulatory guardrails for new state entry and new product development.

Monitors pending legislation and regulations affecting Centene’s commercial business in low to medium risk states. Analyzes, interprets, oversees and prepares communications related to proposed or enacted legislation and communicates findings to impacted departments. Seeks to resolve policy issues which may negatively impact service to members in collaboration with other departments.

Conduct research projects to analyze, interpret and disseminate guidance on legal, contractual and regulatory requirements for assigned states or subject matter expert areas.

Communicate state and federal requirements to internal and external clients.

Develop trust based relationships and collaborates with other functional areas to collect information, follow up with team and others for project deliverables and serves as a Subject Matter Expert. Leads sub-projects and smaller initiatives.

Assist internal and external teams regarding solutions to address potential legal, contractual and/or regulatory issues.

Review filing documentation (including Evidence of Coverage, Schedules and SBCs) and performs quality assurance review on member documentation relating to regulatory requirements.

Assist health plans in managing relationships with regulatory agencies, including state and federal regulators.

Respond to internal and external requests and inquires for information, including from regulatory bodies.

Assist in the maintenance and implementation of department policies, procedures, and work processes.

Performs data entry into Source of Truth used in departmental tracking of regulatory/legislative activity. Maintains internal filing trackers and other reference materials related to work performed.

Performs other duties as assigned.

Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law, MA/JD or equivalent experience required.

2+ years experience in health insurance, legal, or compliance, health policy, or public administration required

2+ years working knowledge of health insurance products, and state and federal insurance regulations required

2+ years experience in commercial health insurance and/or behavioral health managed care preferred

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.