Position Purpose: Completes Qualified Health Plans (QHP) federal and/or state required application templates and documents for low, medium and high risk states, including policy forms for individual commercial marketplace products. 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 high-risk states. Develops and leads special projects and large initiatives, representing the department as a subject matter expert in cross-functional forums. Assume a non-disciplinary supervisory role within Regulatory Operations for the purpose of mentoring junior staff members in their professional growth and support of Centene business goals.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

• Prepares and oversees completion of Qualified Health Plan templates and/or formal regulatory filing documents, seeking approval of our individual commercial marketplace health plans for Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF)filings for high-risk states, ensuring quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements. Mentors and oversees completion of work by junior team members.

• Audits QHP documents for low-medium-high risk states ensuring quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements. Coordinates and oversees audits for the department.

• Develops and implements continuous improvement activities targeting build, audit and quality initiative strategies.

• Leads management of Sources of Truth (SOT) documents for Qualified Health Plan (QHP) filing template and policy form development. Continuously supports SOT creation process and audits complex data inputs across SOT documents and/or as determined by DOI and CMS requirements. SOT is relied on by numerous cross functional teams for benefit and cost share information which is utilized in public and member facing documents.

• Attends, engages and represents their Regulatory Operations team in dynamic cross functional meetings to ensure currency of information related to regulatory and/or market landscape. Leads cross functional teams in data review to ensure Qualified Health Plan (QHP) filing documents are accurate and align with product intent.

• Independently analyzes proposed and/or enacted federal and state legislation and/or regulatory orders to determine impacts to QHP and regulatory filing documents. Interpret regluations and provides impacts and/or risks related to their functional responsibilities which is utilized for advocacy and implementation needs. Leads implementation of new regulations/legislation impacting QHP scope of work and performs updates to policy and filing documents related to implementation. Assists junior staff in their reviews.

• Leads cross-functional implementation of passed legislation or new regulations impacting Qualified Health Plan (QHP) scope of work and/or related policy forms and filing templates.

• Leads onboarding of new employees and training of analysts on essential job duties; maintains and updates training materials. Mentors junior staff in their professional growth.

• Coordinates, develops, monitors, and lead projects internal to the department and cross-functional business partners, 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 all policies and standards

Education/Experience:
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, or compliance or related 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.), QHP Templates (Plans and Benefit, Pharmacy, Crosswalk, etc.) 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

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, 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-related 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. 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act