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 diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Responsible for creation of member contract documents, including Evidence of Coverage (EOC) and related documents, for commercial products for high risk states. Independently performs regulatory and operational research related to EOC and benefit development. Conducts risk assessments, including impact to member contract documentation and downstream output, and monitors pending legislation and regulations affecting Centene's commercial product in high risk states in order to provide updates to relevant member contract documents and provides the business with recommended changes.
- Responsible for performing detailed language analysis of the Ambetter/Commercial Evidence of Coverage (EOC) (member insurance contract) and other relevant member materials, to ensure quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements. Leads initiatives related to these activities.
- Drafts and creates alternative language to include in regulatory member materials, including the EOC, working closely with cross-functional teams, including health plan operational leadership, compliance and legal on approvals. Conducts research projects to provide guidance on legal, contractual and regulatory requirements for assigned states. Seeks to resolve member contract documentation issues which may negatively impact service to members. Leads initiatives related to these activities.
- Serves as a Subject Matter Expert within depth knowledge of health insurance products, procedures, and regulations. Analyzes pending legislation and regulations affecting Centene’s commercial product related to member materials and provides recommendations to the business regarding changes needed to member contractual documents. Performs risk assessment of member contractual materials related to passed and proposed legislation in high risk states.
- Assists in developing junior employees and maintains/updates training materials. Leads updates and maintenance of Policies and Procedures, Work Plans and any department training materials.
- Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.
- Creates, drafts, and revises filing documentation, including but not limited Evidence of Coverage and regulatory checklists, Outlines of Coverage, Enrollment Applications, Notice of Coverage Changes, and Transparency Web Notices. Leads initiatives related to these activities.
- Facilitates EOC review meetings with impacted departments to discuss recommended EOC revisions and language and to formulate solutions/alternatives to proposed contract language for high risk states. Reviews include multiple phases of research, drafting and coordinating of internal approvals.
- Develops and presents communications with alternative viewpoints, including effectively and appropriately communicating during formal presentations and across different audiences. Builds persuasive arguments and secures cooperation of others. Determines the appropriate approach to problem solving, including anticipating barriers to solutions and developing alternative plans.
- Analyzes and creates appropriate responses to questions from regulators related to filing documentation. Works with cross-functional partners for the purpose of crafting appropriate responses and revising regulatory member materials. Leads initiatives related to these activities.
- Performs analysis of benchmark plan information (EHB, State Mandates and Benefit Limits) incorporating changes to contractual documents based on analysis.
- Leads reviews of member-facing documentation (reference guides, letters, etc.) drafted by other Departments for alignment of language and product intent. Responsible for redlining documents and maintaining version control.
- Understands multi-department processes and inter-relationships between commercial departments and operational needs, and maintain trust-based relationships and collaboration with other functional areas in order to lead projects and initiatives.
- May attend external and/or virtual conferences and seminars to evaluate industry trends.
- Performs other duties as assigned
- Complies with all policies and standards
Master's Degree in a related field or Jurisprudence (JD) preferred
3+ years regulatory experience including creation of regulatory documentation, policy analysis and product filings (CMS and/or State DOI) required
3+ years experience in commercial health insurance or a highly regulated industry required
3+ years experience drafting and auditing member contract documentation or related documents. Experience analyzing legislation and/or regulations and conveying findings. Understanding policy issues impacting the healthcare sector preferredPay Range: $68,700.00 - $123,700.00 per year
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
Centene Corporation Dublin, Dublin, IRL Office
Dublin, Dublin, Ireland
