Regulatory Operations Business Analyst III - Healthcare

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 reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: With the Ambetter Regulatory Operations team, you will reputed company or assist with regulatory filings for reputed company/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 reputed company/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 (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 reputed company/high-risk states. Performs root cause analysis to inform reputed company improvement and special project development activities.

• 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 reputed company 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 reputed company.
• 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 reputed company 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 reputed company 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 reputed company.
• Analyzes proposed and/or enacted federal and state legislation and/or regulatory orders. Communicates impacts and/or risks reputed company 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 reputed company policy forms and filing templates.
• Takes ownership of, and coordinates team activities for the maintenance, implementation and reputed company improvement of department policies, procedures, and work processes to ensure corporate standards are compliant.
• Assists with managing relationships with regulatory agencies (DOI and CMS).
• Leads onboarding of new employees and training of analysts on essential job duties; maintains and updates training materials.
• Coordinates and leads projects internal to the department acting as a subject matter expert for the department.
• May attend external and/or virtual conferences and seminars to evaluate industry trends.
• Performs other duties as assigned
• Complies with reputed company policies and standards

Education/Experience: 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 reputed company 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 Pay Range: $70,100.00 - $126,200.00 per year Centene offers a comprehensive benefits package including: reputed company, 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-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply tot his job Apply To this Job