Regulatory Operations Analyst III

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🐊 Florida, New Jersey, +2 more states – Remote

🐊 Florida – Remote 🏖️ New Jersey – Remote 🏈 Ohio – Remote 🚗 Michigan – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Review, interpret, and summarize proposed and enacted legislation and regulatory updates as a subject matter expert • Perform state and federal policy research, regulatory reporting, and regulatory change monitoring • Support compliance, regulatory readiness, and formal regulatory approval of Commercial and Marketplace products • Identify, analyze, and interpret legislation related to Centene’s commercial products and communicate findings to impacted departments • Independently perform risk assessments covering business applications, claims operations, payment integrity processes, and downstream output • Maintain databases, reports, exhibits, and reference materials for legislative, regulatory, compliance, audit, and inquiry activities • Perform complex regulatory analyses and disseminate key Commercial/ACA regulatory updates • Lead regulatory interpretation and explain Commercial/ACA rules to varied audiences • Provide guidance on emerging regulations, regulatory inquiries, audits, fraud, waste and abuse oversight, and payment integrity matters • Coordinate regulatory inquiries, reporting requirements, exhibits, audits, and agency requests • Partner with Compliance, SIU, Payment Integrity, Claims Operations, Finance, Legal, and other cross-functional teams • Identify regulatory risks, support investigations, and analyze operational trends • Develop solutions and draft responses to legal, contractual, regulatory, filing, and policy matters • Represent the department in cross-departmental meetings and escalate matters to management • Understand regulations and business needs across multiple states and federal commercial health insurance regulations • Assess objections related to regulatory interpretation and lead responses provided to regulators

🎯 Requirements

• Bachelor’s Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required • 4+ years of experience in health insurance, legal, compliance, or a related field required • Experience reviewing regulations and providing audience-appropriate interpretation preferred • Experience in commercial health insurance, Medicaid managed care, claims operations, compliance, payment integrity, or related healthcare operations preferred • Experience partnering with SIU, Compliance, FWA, Payment Integrity, or related operational teams strongly preferred • Experience supporting claims operations, including medical claims processing, provider billing practices, payment accuracy, reimbursement workflows, or claims-related regulatory activities strongly preferred • Experience analyzing claims data, billing trends, overpayment activity, provider utilization patterns, or operational risk indicators strongly preferred • Experience supporting regulatory audits, investigations, agency inquiries, corrective action plans, or regulator-facing responses strongly preferred • Proficiency with Excel and reporting, analytics, or business intelligence tools such as Power BI, SQL, SAS, or similar platforms strongly preferred • Experience within Medicaid managed care, including MFD, MFCU, payment integrity, TPL, or recovery activities strongly preferred • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off • Holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation