Senior Insurance Product Compliance Professional

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Manage the annual On-Exchange (ACA) form, template, and supporting documentation submission process for Qualified Dental Plan certification activities • Monitor and analyze state and federal regulatory requirements and assess impacts on contract language • Provide consultative guidance to team associates on regulatory requirements • Coordinate legislative updates between Group and Individual products • Collaborate with teams on requirements affecting existing products, new products, and product refreshes • Create awareness of regulatory issues and ensure compliance for new and existing policies and related forms • Write generic and state-specific contract language for Individual Specialty policies • Facilitate reviews and finalization of contract language and assist with regulatory approval negotiations • Research and develop responses to regulatory objections, exams, and inquiries • Maintain documentation supporting the rationale for new or revised contract language • Conduct quality reviews of generic and state-specific policy forms • Serve as subject matter expert for assigned Specialty lines of business and topics • Triage and answer compliance questions regarding policy and certificate language • Assist Professional 2s with drafting state forms and understanding filing requirements • Ensure project tracking information is accurate and current • Support product filings, including drafting, filing, and implementing production forms and annual On-Exchange product filings/binders • Recommend and support process improvements • Draft or contribute to work instructions and process documentation • Provide training and support to associates • Prepare standard policy forms for regulatory filings and implementation • Consult on application filing issues and coordinate applications for Individual Specialty products • Conduct or assist with research requests • Perform other assigned duties

🎯 Requirements

• Bachelor's Degree or equivalent experience in a healthcare/insurance compliance function • Minimum 5 years of healthcare/insurance industry experience • Knowledge of laws and regulations governing the healthcare/insurance industry, including state Departments of Insurance and CMS • Ability to research and analyze state laws and regulations • Understanding of insurance products, including policy language • Proficiency in Adobe Acrobat and Microsoft 365 applications, including Word, Excel, Teams, and SharePoint • Excellent oral and written communication skills • Ability to collaborate effectively with associates across all organizational levels and reviewer-level state/federal regulators • Demonstrated attention to detail and accuracy • Proven analytical and problem-solving ability • Self-motivated and task-oriented, with ability to manage multiple priorities and work under pressure to meet deadlines • Dedicated work-from-home space without ongoing interruptions to protect member PHI/HIPAA information • Home internet service with minimum 25 Mbps download and 10 Mbps upload speeds • Auditing or consulting experience preferred • Project coordination or project management experience preferred • Experience with SERFF preferred • Experience with annual On-Exchange ACA form/template submission process and HIOS systems preferred • Experience with stand-alone Dental and Vision insurance products preferred • Experience creating and delivering reports and presentations preferred

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Remote work arrangement • Dedicated work-from-home space • Internet service meeting minimum speed requirements