Regulatory Operations Analyst III

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 complex topics. Lead assigned special projects and perform/support various reporting functions. Ability to understand the needs of the Department and inter-dependencies with other departments. Ability to work independently on tasks. Leads the research and regulatory guardrails for new state entry and new product development.

Monitors pending legislation and regulations affecting Centene’s commercial product at the federal level and in high risk states. Performs risk assessments, including impact to business applications and downstream output.

Communicates state and federal commercial/Affordable Care Act requirements to internal and external clients.

Lead for regulatory interpretation for the commercial product.

Support business partners with implementation of passed legislation or new regulations providing regulatory interpretation when needed.

Analyzes and interprets proposed or enacted legislation and communicates findings to impacted departments.

Ability to understand multi-department processes and inter-relationships between commercial departments and operational needs to assist in understanding impacts of proposed legislation/regulations.

Support internal and external teams regarding solutions to address potential legal, contractual and/or regulatory issues. Including using persuasive arguments and securing cooperation to take action.

Conducts research projects to analyze, interpret and disseminate guidance on legal, contractual and regulatory requirements for assigned states. Seek to resolve policy issues which may negatively impact service to members.

Develops trust-based relationships within varied audiences and collaborates with other functional areas to lead projects and initiatives.

Explain complex concepts clearly and adapt language and presentation based on the audience level.

Serves as a Subject Matter Expert for department functions.

Coordinates/attends cross-departmental meetings as department representative and appropriately escalates matters to management.

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

Provide guidance on regulatory requirements for QHP templates and other supporting documentation needed for filings.

Support and manage relationships between health plans and regulatory agencies, including state and federal regulators. Responds to external requests for information required by the organization for its regulatory filings and/or for policy needs.

Assist in assessment of objections with cross-functional partners for the purpose of crafting appropriate responses for regulators.

Develops and spearheads new projects with a focus on communications, workflow, and quality initiatives.

Determine the appropriate approach to solving a problem.

Assist legal with COA application materials/submissions for new states and/or products.

Assists in developing junior employees and maintain/update training materials.

Maintains database and other reference materials related to legislative and regulatory issues and compliance.

Performs data entry into Source of Truth used in departmental tracking of regulatory activity.

May attend external conferences and seminars to evaluate industry trends and training materials.

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, or compliance required. Experience preferred in commercial health insurance and/or behavioral health managed care required

4+ years experience reviewing regulations and providing interpretation using terms appropriate for the audience required

Pay Range: $67,400.00 - $121,300.00 per yearCentene 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.