Regulatory Operations Business Analyst IV

Job not on LinkedIn

🔥 1 minute ago

🐊 Florida, Illinois, +5 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🗽 New York – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Business 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

• Complete Qualified Health Plans (QHP) federal and/or state application templates and documents, including policy forms for individual commercial marketplace products • Review and interpret application instructions from Departments of Insurance and CMS • Develop and implement auditing and monitoring strategies for high-risk states • Prepare and oversee QHP templates and regulatory filing documents for HIOS and SERFF filings • Ensure quality control, regulatory compliance, organizational standards, and alignment with internal operations, products, and financial arrangements • Mentor and oversee junior team members and support their professional growth • Audit QHP documents for low-, medium-, and high-risk states and coordinate department audits • Develop and implement continuous improvement, build, audit, and quality initiative strategies • Lead management, creation, auditing, and maintenance of Sources of Truth documents • Represent Regulatory Operations in cross-functional meetings and lead data reviews • Analyze federal and state legislation and regulatory orders and determine impacts and risks • Lead implementation of new regulations and legislation, including updates to policy and filing documents • Lead onboarding and training of analysts and maintain training materials • Coordinate and lead internal and cross-functional projects as a subject matter expert • Attend external and virtual conferences and seminars to evaluate industry trends • Perform other duties as assigned

🎯 Requirements

• Bachelor's Degree in Business, Communications, Health Care, Political Science or equivalent experience required • Master's Degree in a related field preferred • 6+ years business process or data analysis experience in health insurance, legal, compliance or related area required • Experience in commercial health insurance and/or behavioral health managed care preferred • Experience drafting and auditing filing documentation, QHP Templates or related area preferred • Experience auditing database or QHP filing documentation preferred • Experience analyzing legislation and/or regulations and conveying findings preferred • Knowledge of SERFF and HIOS systems preferred • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Must comply with company policies and standards

🏖️ Benefits

• Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity