Company

Centene Corporation

Description

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.

Position Purpose Performs or assists with regulatory filings, seeking approval of commercial products for the commercial markets, and/or performs policy research and issue advocacy. Guides special projects; provides regulatory interpretation; and assists in the development of and implementation of auditing and monitoring strategies. Responsible for creation of QHP templates and/or member policy documents, including Evidence of Coverage and schedules, for commercial products for high-risk states. Serves as the business owner responsible for working with IT on system enhancements and/or fixes to the product benefit database. Owns the preparation and filing for new state entry and new product development.

In depth knowledge of health products, procedures, and state insurance regulations.
Develops trust based relationships and collaborates with other functional areas to lead projects and initiatives. Serves as a Subject Matter Expert for department functions and regulatory interpretation for the commercial product.
Ability to understand multi-department processes and inter-relationships between commercial departments and operational needs.
Coordinates/attends cross-departmental meetings as department representative and appropriately escalates matters to management.
Reviews filing documentation (including Evidence of Coverage) for certain states.
Supports and manages relationships with regulatory bodies, including state insurance regulators and state based exchanges. Responds to external requests for information required by the organization for its regulatory filings and/or for policy advocacy.
Conducts regulatory research for new states and/or products.
Communicates assessment of objections with cross-functional partners for the purpose of crafting appropriate responses for regulators.
Communicates state and federal commercial (QHP) requirements to internal and external clients.
Monitors pending legislation and regulations affecting Centene’s commercial product in high risk states. Performs risk assessments, including impact to business applications and downstream output.
Analyzes and interprets proposed or enacted legislation and communicate findings to impacted departments.
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.
May attend external conferences and seminars to evaluate industry trends and training materials.

Education/Experience Bachelor’s degree in Business, Communications, Healthcare, Political Science/ Pre-Law or equivalent experience. 4+ years of experience in health insurance, legal, or compliance required. Experience in commercial health insurance and/or behavioral health managed care. Knowledge of SERFF and HIOS preferred. Experience drafting and auditing policy documentation or QHP Templates preferred. Experience auditing database or documentation preferred.

Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

Identifier

7cf73065fde07571b781709e617fbbbb